Article written by Dr. Nita C. Mahajan, Kaiser Permanente
Approximately one year ago, Kaiser Permanente South Bay Medical Center admitted our first patient infected with COVID-19. Little did we know that this new virus, discovered only a few months earlier in Wuhan, China, would define nearly every aspect of our lives for at least the next twelve months. Now that infections are declining, I can begin to see rays of light in this year filled with so much hardship
As the COVID-19 pandemic began, my role as physician director for ambulatory quality and complete care quickly pivoted to providing clinical oversight for our ambulatory COVID-positive patients. These are patients who have tested positive for COVID, but whose symptoms are not severe enough to warrant hospitalization. Our team—comprised of more than 20 nurses, physicians, and staff—monitors these patients virtually through remote diagnostic equipment, as well as video and telephone appointments. This was one of the early “aha” moments of the pandemic: the effective use of technology would be critical to protecting our patients, staff, physicians, and communities. Kaiser Permanente has long used technology to support patient care, so the question was not how or if to use these tools. We simply needed to determine the best way to apply them to meet the current challenge.
Our patients also needed to adjust. For years, I have encouraged patients to take advantage of telehealth options to provide easier access to care. Now, in light of the COVID pandemic, more patients than ever are scheduling video appointments and finding that the technology supports, rather than replaces, the human connection. In truth, much of what we do as physicians is communicate with our patients. Diagnostic tools are certainly helpful—and technology has made it so that those can be used remotely, as well—but most of the information I need to provide medical advice is from the patient. My expectation is that, while many in-person appointments will return, we will forever see telemedicine as a viable and sometimes preferable option for care delivery.
Members of the Emergency Early COVID Treatment Center leadership team, from L-R: Jeri Wiley, RN, Dr. Nita Mahajan, Girlie Millanes, RN
Integration: Caring for Body, Mind & Spirit
As we cared for patients we found that, while our interaction may have started with a focus on their symptoms, the conversation often turned to non-medical issues that they were struggling with, like how to isolate effectively at home when you’re parenting young children. Some shared how scared and lonely they were, the combination of social distancing and illness causing extreme anxiety. And some were grappling with grief following the death of a loved one from COVID-19. Fortunately, Kaiser Permanente’s integrated care delivery system made it easy for us to provide these patients with warm hand-offs to those who could offer appropriate support, such as a therapist from our behavioral health team.
That integrated system was also leveraged when COVID-related symptoms became more severe. Being able to coordinate that patient’s arrival in the Emergency Department or Urgent Care Clinic made it easier to keep everyone safe—including other patients, visitors, staff, and physicians. It also helped the patient to feel more prepared. Knowing what to expect is critical to addressing fear and anxiety.
In the Darkest Moments, Connection Lights the Way
The days and nights in the hospital were long. It was an assault on the senses: the smell of hand sanitizer, the sight of a triage tent in the Emergency Department that made it look like we were walking into battle, and the inability to place a reassuring hand on the arm of an anxious patient. Worse was hearing the hospital loudspeaker announce, “Rapid Response, Unit X,” signifying that somewhere in the
hospital a patient was fighting to live. Mentally, emotionally, and spiritually, it became the most difficult time in my career as a physician. Fortunately, someone had the idea to play Journey’s “Don’t Stop Believin’’” over the loudspeaker every time a COVID patient was discharged from the hospital. There were days that the sound of that 80’s rock song playing overhead kept me going. It meant that we had been able to save someone from this terrible virus.
While PPE prevented us from sharing smiles with colleagues in the hall, our team found other ways to show their support. One night, a few administrative staff members created beautiful chalk art to boost our spirits. For weeks we had lunch and dinner donated from area restaurants—the same restaurants that we knew were struggling to keep their doors open during the pandemic. The incredible generosity was not lost on any of us who received these meals.
A thank you note from Caroldale Elementary School in Carson
By far, the greatest motivation came from our patients themselves. There is nothing quite like seeing a patient who had been seriously ill go home to their loved ones. Their words will likely stay with me forever. One patient wrote, “I have never seen the doctors, nurses, and health care staff work so hard and with no rest as I have seen in the past few days. They are certainly the 'light' that is keeping so many comforted and alive right now.”
The Incredible Triumph of Innovation
If anything has triumphed over the past year, it is the innovative spirit. Early on, we saw businesses pivot to meet the needs of our community. For example, Mattel paused production of Barbie’s wardrobe to sew facemasks, Gallo wines began producing hand sanitizer, and Philips66 created face shields. Innovation occurred in health care, as well, with the rapid production of life-saving therapies, like remdesivir, and the incredibly effective COVID vaccines.
My current role at Kaiser Permanente South Bay includes overseeing our Emergency Early COVID Treatment Center which gives therapy, such as remdesivir, to clinic patients ill with COVID-19. Using data, we have been able to proactively identify the patients who might benefit from this new therapy and bring them in for treatment. After just two doses of this intravenous medication, for some of our patients, we see marked improvement. As a result, patients who are very ill and would have been at grave risk of not surviving less than a year ago, now have a highly effective option for care. They can recover in the comfort of their own homes and go on to live their lives. I consider our clinic one of the most positive spaces in the hospital because, even though we’re caring for very sick patients, they are overwhelmingly doing well.
Of course, the COVID vaccines now being deployed are another example of innovation—and they’re also a great cause for hope. We are seeing vaccines that are highly effective—Pfizer and Moderna both more than 94% effective—delivered to the public with such speed, and without cutting any corners for safety. Imagine if we could apply this innovative spirit to developing treatments for cancer, diabetes, or ALS? I am filled with hope at the recognition of how much we can accomplish with shared focus, collaboration, and urgency.
Last, but Not Least, The Flu
As physician flu champion for Kaiser Permanente South Bay, I’d be remiss to not mention one last silver lining to our year of COVID: a year without the flu! As evidence of the impact of social distancing, increased vaccination, hand hygiene, and wearing a facemask, we saw extremely little flu activity this
winter. While flu and COVID-19 have differences, they are similar in that flu is also a contagious respiratory virus that can make many people—particularly those who are older or with health conditions—seriously ill. If we can continue these practices, it will save tens of thousands of lives each year from these contagious viruses.
Hope for a Healthier Tomorrow
It feels trite to say that in every challenge lies opportunity but, if the COVID pandemic presents the greatest public health challenge of the past century, it would feel like a missed opportunity to look backward. Embracing technology could reduce barriers to care, particularly for those who in live in rural or underserved communities. Carrying preventive behaviors into the future gives us the opportunity to build a healthier tomorrow. As restrictions subside and our calendars become busy once again, I hope that we remember the power of kind words and notes of encouragement.
I know that we all want to go “back to normal,” but my hope is for something better—a healthier, more connected future where we can safely enjoy all those activities that we’ve missed. If the last year has taught me anything, it’s that there is always cause for hope
Dr. Nita C. Mahajan, Kaiser Permanente
Dr. Nita Mahajan is an internal medicine physician practicing at Kaiser Permanente South Bay in Harbor City. Dr. Mahajan serves as the physician director of ambulatory quality/complete care with clinical oversight of the medical center’s outpatient COVID-19 care, including a division of employee health services.