Even before the coronavirus arrived in the United States, forward-thinking physicians at Upstate Medical University saw the signs and got ready for action. Their quick response, paired with a culture of institutional preparedness and creativity, helped Upstate respond effectively to the crisis. Today, its hospitals and practices are open for business across all of its clinical areas, as the commitment to addressing COVID-19 continues.
As word of COVID-19 reached the U.S. in January, infectious disease specialists at Upstate, including Stephen Thomas, MD, Division Chief of Infectious Disease and Director of the Institute for Global Health and Translational Sciences, began tracking developments in China. These physicians communicated with Upstate’s leadership, who responded with alacrity. The promptness took some of their colleagues by surprise, but their forethought was soon lauded.
“In early January, Paul Suits, Director of Infection Control, convinced our Logistics Department to purchase a big shipment of N95 masks,” Dr. Thomas says. “Initially, they asked, ‘Why are we doing this?’”
Suits, Dr. Thomas and their colleagues pointed out that when the Ebola virus outbreak took place in West Africa, equipment was difficult to obtain worldwide because only a limited number of sources make medical-grade protective gear. If the coronavirus reached the U.S., it would be problematic.
Obtaining masks represented just one aspect of the preparedness Upstate demonstrated in the early days. Robert Corona, DO, MBA, Chief Executive Officer of Upstate University Hospital, knew that Upstate, and the entire Central New York region, could soon be facing some serious needs. When approached by Chris Dunham, Director of Emergency Management at Upstate, Dr. Corona activated the Incident Command structure, which stands ready to respond to crises.
University Hospital staff working with PPE
“Even before executive orders or recommendations were issued, we had a team of more than 70 people discussing our response to COVID-19,” Dr. Corona says. “This is the longest-serving Incident Command we have had.”
Formally convening in mid-March, Incident Command met twice daily, discussing needs that included rescheduling elective procedures, freeing hospital beds for potential COVID-19 patients, cleaning and decontaminating, and testing and communicating with the wider community. The meetings were held twice daily — weekends included — with more than 100 people on the Zoom calls to hear and act on the reports. Everyone wanted to play a part and learn as much as they could about how to keep patients safe.
“Facing a pandemic was such a complex challenge, and everybody was interconnected in some way,” Dr. Corona commented. “The structure we set in place also provided the necessary transition to our reopening, and now to full operations.”
In early spring, Upstate rapidly transitioned most outpatient visits in the majority of its 19 clinical departments to telemedicine and continues to offer the option for many types of visits. When patients do not need to be physically present, telemedicine provides a convenience and helps both patients and providers maintain social distance.
“Telemedicine has been something we have been readying ourselves to do for years at scale, and the crisis showed that this was viable,” Dr. Corona says.
“Each of our departments is focused on safely handing referrals, being in touch with referring physicians and seeing patients within their comfort zones. Every service at Upstate Medical University is open for referral.”
— Robert Corona, DO, MBA Chief Executive Officer of Upstate University Hospital
Resources of an academic medical center
From the start of the pandemic, Upstate took its position as an academic medical center seriously — caring for patients, pursuing research into COVID-19 and possible treatments, analyzing data, and advising the public about the crisis as it developed. In their public-facing role, Upstate leadership drew on data modeling from its own public health experts to predict the spread of the pandemic. Drs. Corona and Thomas, as well as others, became a reliable “voice of the pandemic” for Central New York.
Robert Corona, DO, MBA, Chief Executive Officer of Upstate University Hospital, and Stephen Thomas, MD, Division Chief of Infectious Disease and Director of the Institute for Global Health and Translational Sciences, became trusted voices of the pandemic for Central New York. Both doctors gave interviews to local media, including Channel 9 TV.
Some of the communication resulted from information gathered about the virus and the population’s influence on its spread, sharing that information with the public and, in turn, influencing the public’s response. For instance, Upstate public health experts discovered that cell phone data could help predict the virus’ spread. Areas where people were on the road more frequently experienced a surge in cases shortly thereafter.
Dr. Thomas, who was a frequent commentator in the media explains, “The data could be used as a ‘stick’ and ‘carrot.’ Based on what was happening in our community I could tell the public, ‘You’re out too much, and there’s a direct association with infections growing’ or ‘You’re doing a great job staying home, and infections are going down.’”
Upstate’s Department of Public Health and Preventive Medicine supplied much of the data and analyses that informed the public, government officials and countless areas within Upstate. As part of the College of Medicine, the department consists of epidemiologists, biostatisticians, data analysts, coordinators, community health and social scientists, who continue to provide ongoing reports and monitoring. Department Chair Christopher P. Morley, PhD, says the team is helping Upstate create a playbook that can be used for future waves of the coronavirus or another pandemic. For real time updates, faculty members Telisa Stewart, MPH, DrPH, public health, and Kathryn Anderson, MD, PhD, medicine and microbiology, immunology, helped to establish systems with a dedicated internal IMT team to collect, analyze and report infection data to Upstate leadership and Central New York.
“Being an academic medical center creates a huge advantage during this time,” Dr. Corona says. “We have experts to talk in public forums, answer media questions and meet with large groups, like manufacturing associations and other entities, to talk about how they can keep people safe. Now as more is known about the effects of COVID-19 on patients, we also have experts to address those varying aspects — from pulmonary to neurological to cardiovascular.”
Recovery and Resilience
After more than two months of constant vigilance, Incident Command wound down and was replaced by a month in Recovery Mode, guiding the safe, full reopening of clinical services in late June. Upstate has now transitioned to a phase dubbed “Resilience” by the C-suite. The aim for Resilience is continue to improve by optimizing operations and rapidly adopting innovations using a Tiger Team model. Amy Tucker, MD, Chief Medical Officer at Upstate University Hospital, led the recovery effort, and is now spearheading its Tiger Teams initiative. She explains that these goal-oriented teams convene for a focused period to rapidly meet emerging needs. The process is tied to the hospital’s strategic pillars, with each member of the C-suite overseeing teams that relate to their areas.
“With our Tiger Teams we aim to streamline operations and to nimbly adopt innovation so that we serve patients and our colleagues even more effectively,” Dr. Tucker commented.
“Today, as we have been all year, we are finely attuned and responsive to the needs of the community,” Dr. Corona says. “We are committed to being a safe place for patients to come. And, we are committed to being a supportive partner to the physicians who refer their patients to us. We want the community to know that we are open and safe.”
Director of Transitional Care Diane Nanno, MS, CNS, RN, NE-BC, CCCTM, with the comfort care kit
As Upstate breathes a sigh of relief and resumes visits and scheduled procedures at every location, Dr. Thomas also notes that the pandemic has enhanced the mutual respect and solidarity between the academic medical center and Central New York’s community practices. It’s a dynamic he hopes will flourish into the future.
“Everybody who works in the medical environment stepped up to ensure hospitals had space to care for the sickest patients,” he says. “For that to happen, we had to have all hands on deck. Primary care providers and community subspecialists knew they would see people who might have COVID-19. We had multiple meetings with our medical community, and physicians told us, ‘We signed up for this. We understand the risks. If you provide the PPE, the training and the means to take samples, we will see these people in our offices.’ The community really came together, and it went well.”
For more information, visit upstate.edu/together.