Transcript

Russell [00:00:02] Let's get stronger.

Gates [00:00:04] Healthier.

Prickett [00:00:04] Calmer.

Russell [00:00:05] Smarter.

Gates [00:00:06] Better.

Russell [00:00:07] Living a healthier life is a journey, not a destination.

Gates [00:00:10] You can always get better.

Prickett [00:00:12] Let's get better together.

Gates [00:00:20] Every pandemic has an end, but what will it take for the COVID 19 pandemic to be over? Hi, I'm Dr. Khalilah Gates.

Russell [00:00:28] I'm Dr. Susan Russell

Prickett [00:00:29] and I'm Dr. Michelle Prickett.

Gates [00:00:31] Today, we look back on the past two years on the front lines of the COVID-19 pandemic at Northwestern Medicine, and we look forward toward the future. We'll talk about what's gotten us through and what we’ll take with us through the end when the COVID-19 pandemic is finally declared over. Let's talk about what it looks like in the COVID ICU.

Russell [00:00:52] So I've told patients who've asked me that I'm cautiously optimistic that we're turning the corner, turned the corner? And then I feel like I need to like knock wood throw salt. Even if Chicago looks a little bit better, certainly across the nation, we have not seen that trend bear out everywhere, and there are definitely places that are still on the up. So it's not the time to kind of pull the pedal off the brakes on all the being cautious, but maybe take a little breath.

Gates [00:01:23] Absolutely. I think this week about half of my service is running COVID positive and the other half is non-COVID, and we're still seeing really hot, really bad COVID patients.

Prickett [00:01:35] I think the question I'm getting from people, just people in the community, patients that I'm seeing in clinic is who are the patients that we're seeing? Are they vaccinated? Are they unvaccinated? And what do they look like? And how is omicron? And we've essentially been seeing omicron since Christmas now based on our data. But even with this last surge, there is a difference between the vaccinated and the unvaccinated. So I've noticed, I know what you all think, but I've noticed that those that are unvaccinated are coming in COVID classic. They look just like they did two years ago. There is a lot of respiratory failure, a lot of clots, a lot of bleeding, and a lot of unknowns. Those who are vaccinated, really haven't seen a lot of boosted patients coming in, certainly have seen a lot of immunocompromised patients. And fortunately, this particular wave doesn't seem as respiratory intense as we've seen previously. But I think a lot of it has to do with the vaccination status, and we've been seeing quite a few vaccinated patients having better outcomes, but still coming to us in the ICU.

Russell [00:02:33] Yeah. And I felt like it was especially true, patients who were vaccinated but not boosted, and their second vaccine dose was in kind of that bubble time of being about four, five months plus ago that we've been seeing in the ICU. And in general, the ones that I've seen that have been boosted in the ICU have had some other comorbidity that kind of played into how you think their immune system behaves in general.

Gates [00:03:00] Absolutely. And I also find that people are like, I got my vaccine, I was boosted like, why do I still have it? And I stress to those patients that it definitely attempts to minimize the severity of the infection. So, yeah, it feels different.

Prickett [00:03:15] It feels different from when it all began, and it certainly seems to reduce the severity. So what those that are vaccinated certainly are having typically kind of generally better, shorter courses, better turnaround time, but still having pretty significant disease and coming to us in the ICU and the hospital.

Russell [00:03:34] And we've seen that ICU and hospital length of stays are shorter than they were with the delta-based surge last winter. But it's really too soon to call because a lot of patients that are getting sick tend to be sick a while before they end up in the hospital. So it's really going to depend on us looking back at our numbers in a couple of months to know for sure that the surge or the severity of illness is better than the previous times around. The pandemic has changed everything. What are the changes that are going to be permanent and what do we think is going to continue to be different even after we're kind of over the COVID hump?

Prickett [00:04:11] Well, I think we've seen how when you do something not just individually but collectively, it can have a big impact on health, right? So I think for me, understanding the importance of masking, you know, not all day, every day from here on out, but the importance of masking, especially during respiratory viral seasons. We will always have those around us that are medically vulnerable because their immune system’s low, because of cancer, because of a transplant or something along that line. So I think, you know, masking is something you're going to see specifically around at least certain timeframes and in certain populations to keep groups healthy. And hopefully we'll continue to see hugging. But I think, you know, masking is really, for me, something that I think we've seen the benefit, we've proven we can do, and I think we can have some alterations in it based off of what's prevalent and where things are at. But certainly, I think moving forward, that's one thing that I look at as a positive and learning about how we can keep each other safe.

Gates [00:05:09] Absolutely. I was in clinic, I think, last week and a patient was like, “You know, I usually get something every year, and I don't have, it is very interesting.” I was like, “It is not interesting, it is the mask.” (laughs)

Prickett [00:05:22] Now most of my patients have chronic coughs, and most of them have lung infections that get exacerbated, and they're usually exacerbated by viruses. And so it's been a big plus. So, you know, we've seen it on many levels and I think for me, normalizing it, so you will never see me, probably in clinic without a mask, you will certainly never see me on a plane without a mask. Like, I don't need to get sick before I go on my vacation, wherever I'm going to go. Exactly. I want to keep myself nice and healthy, and I think that's a lesson. As well as testing, we've really access to testing one to test. I think that's something that we've improved upon. There's still more improvement to go and how best to use it. But that's another, I think, lesson we can take away.

Gates [00:05:58] I think we're kind of heading to this idea of how do we move forward? What does that look like? And I think part of that, at least for me, is how do we figure out how to live with COVID. Because there will be an end to the pandemic, I believe, if we look back at history and understand some of the epidemiology of it. But just because the pandemic ends doesn't mean COVID just goes away as rapidly as it came. And so what does that look like? How do we move forward?

Russell [00:06:27] I think a lot of people have talked about that transition from being a pandemic to something that's endemic, which means that the infection exists in your community, but it's never something that overwhelms hospitals or puts a strain on the system where it disrupts your day-to-day life. And I think that's what most of us are kind of hoping for at this moment, that we kind of get towards that state. And that means that you don't have to kind of think about whether you're going to be able to go out to dinner next week based on the numbers in your community. But perhaps you know it exists. And if you do get sick, it's not as bad as it would have been if we didn't know much, and the virus was so virulent. And there will be vaccines available to help prevent spread. But there will be people who get sick on a year-to-year basis, and it'll be some people in the hospital all the time who have this disease. But it will never be to the point where we have to cancel concerts and shut down restaurants and close schools because of the infection. But it's something we live with, rather than something that dictates our lives. And I think that's what most people are hoping we're transitioning towards.

Gates [00:07:40] And I hope we've learned something. I believe that everything that we experience is a learning experience. So we look back at what we've gone through these two years and we say, “What do we learn from this?” One is: Mask everywhere you go.

Russell [00:07:53] And keep sani[tizer] in your car at all times.

Gates [00:07:55] Sani in your car, burn your hands with the sani. But how has this pandemic changed us for the better? And it has caused us to really look at some of our practices and really think about some of our structures and the things that we do, and I'm hoping that we really carry some of those things forward as we move towards a more endemic COVID-19 virus or variant. I should say, people always say like, “When do we get back to normal?” I don't want to be back to normal because normal allowed us to get here. And so, what do we look like when we move out so that we're better for the next time around?

Russell [00:08:32] Yeah, I don't know if it will happen, but I hope that people are more thoughtful about staying home when they're sick. Yeah. You know, I think before the pandemic, it was a badge of pride like, “Oh, you don't look good. Why are you here today?” (fakes cough, laughs)

Prickett [00:08:50] That was a great reenactment, by the way.

Russell [00:08:54] And I hope that afterwards, people are kind of thinking twice about that kind of behavior.

Prickett [00:08:59] Yeah, I think for me, it like just recognition of like, don't bring, you know, if you're ill, don't bring it in. Like, keep it to yourself. We've gone two years without doing all the things we want to not have a lethal infection. It may not be lethal for you, but it may be lethal for others, right? Like again, always going to be people that have transplants or chemotherapy. So recognizing and embracing that is really protecting your community and not just slugging through. But I think, you know, we've certainly learned so much from this. I've learned so much from this. I think as a community, we've learned. And really seeing how similar we are, but also how different we are, and how we can think differently. So when did we ever think that we could be working from home on Zoom or having like all the things that we've done that really have its challenges for sure? But like, let's just be home faster. Doing take-out from restaurants, too, as an alternative, and still supporting our community businesses and things like that. Like, I think there's a lot of things that we have kind of shifted in our life that are for the benefit. And I think for me, the biggest benefit is knowing what's important, knowing who's important really is probably the better way to say that, and prioritizing them and understanding how things fit within that spectrum and prioritizing people. And for me, as people, I've been seeing, you know, my family, but it's also you all that I work with, see every day and you know, all the folks in the hospital and the clinics and the patients that we've seen that making sure that they're the most important things to us with whatever else is going on, we could figure it out. We can get through this and move forward safely and healthily and be better.

Gates [00:10:29] And in that, like we all talk about it being endemic and continue to wear the mask and things like this. And I think at this point, we should make sure that we don't give the impression or we remind people that even when we're moving forward, even when we are endemic instead of pandemic, that COVID could potentially still be problematic for some, just like influenza is problematic for some, right? Thousands of people unfortunately still pass away from influenza. So I think in the same vein, we will still have people who don't do as well with COVID-19 once endemic. But I think the things that we think about and remind people are things like the importance of vaccinations and that would be flu, that would be pneumonia and probably COVID as well. And again, just because it's declared over at some point, it's not really over. And I think we have to move forward with that idea in mind as well.

Prickett [00:11:29] And it also brings up the idea of even if we say COVID ends today, there's a miracle it's eradicated after the face of the Earth, there are still going to be long-lasting effects that we're going to be dealing with again in health care as well as a community. So in health care, there's long COVID. There's all the complications of those that have had the infection and have long-lasting issues from it physically and more importantly, the emotional burden that has come with us. And so even if we get to the state — and I'm hoping we do, but it's part of me is just like, I'm never going to say, hang my hat quite there until I see it. But even if we do, if we miraculously do today or tomorrow, there's still so many impacts from this that we need to recognize and manage and acknowledge and give it space and time. Knowing that again, everyone's had an individual experience with this. For some, that is physical. For some that is emotional, and some that is true loss of a loved one, friend, partner that is never going to go away. So to me, I think as we move those lessons forward, remembering we don't know everyone's struggles unless we ask, unless we talk about it and destigmatize that discussion and recognizing it is kind of, I think, how I would look moving forward.

Russell [00:12:36] And I think a lot of people are going to have a lot of reentry issues as we hopefully transition out of this pandemic, and it's going to be important for us to be kind to each other just like we tell our children, be kind, Golden Rule, that we acknowledge we don't know like where everybody's been or where they haven't been in the last two years. They've been stuck inside their house. And that we just take it one day at a time, one step at a time, and think about where everybody's coming from and what sort of things they might be dealing with on a day-to-day basis, just like Michelle said.

Gates [00:13:11] Absolutely. And I think that one of the things that this pandemic has highlighted for us is the importance of wellness and mental health across the board, and the impact that isolation has on us. We are social beings. And what does that mean when that is taken away? And how do we come from two years plus of not doing the things that make us who we are as humans and, as Russell said, kindness, but also grace. Give us each of us the opposite of each other the opportunity to readjust.

Russell [00:13:43] Yeah, I was having a conversation with somebody about going back to a medical conference. And before the pandemic, we would have these international conferences with thousands of people present and, you know, they were just talking about like whether things were going to get back towards that this year or next year. And I was like, I don't know, but I can't wait (laughs).

Prickett [00:14:06] Yeah, there's some things you can't wait to get back to you. And some things are like, “Why did I do that?”

Russell [00:14:10] Yeah.

Prickett [00:14:10] But I think for all the message I'm hearing, and I totally agree with this, we're all going to have our different like little hang-ups. And just acknowledging that and give space for it, say if that's your thing, be it your thing. And if you grow out of it, great. If not, and that's what you hang on to, that's OK. That's OK. But just allowing people to move forward at their own rates with their own comfort level and again, kind of asking, like feeling them out is, “Can I give you a hug? Can I sit here?” Things along those lines just to make sure people feel comfortable at their own time, at their own place. And if they don't really again, maybe they do have a health condition, and we just need to be acknowledging that that's OK, too. We just need to keep that up there.

Gates [00:14:53] I think we all agree that it feels different. We are grateful for vaccines and the impact that they have had on the pandemic. But I wanted to talk about now, besides vaccination status. What do we think, or what have we seen? What else has impacted our outcomes here at Northwestern Medicine during the pandemic?

Prickett [00:15:14] I would say teamwork, honestly. Being proactive, even though there were the experts we had never seen before. So it was learning on the job, but it was learning with others and communicating our needs, using the data to leverage our decisions and reinforcing that. So I do think that that was probably one of the biggest challenges and one of the biggest successes is learning from each other, having some humility in how we care for these patients and not just doing it, how we would take care of flu patients, for example. It's been a lot different than what we all have seen over the years of acute respiratory distress syndrome and respiratory failure. But I think it's how we've worked together on a collective system: physicians, nurses, therapists, it's everyone. Supply Chain, Environmental Services, cleaning the rooms command — I call it mission control. But just letting us know where we stand and what the flow is so that we can address, identify, address and intervene on the most critical patients to get them through. I think that's what I have seen has been the biggest change and benefit to our outcomes here at Northwestern.

Russell [00:16:17] Yeah. And I think even though there is a lot of COVID that we did not understand and that we were learning as we went along, we also kind of know a lot of the backbone of good patient care and good ICU-based care. And so I think part of the reason that at Northwestern, our outcomes earlier on were relatively better compared to other parts of the country or the world is because we were able to scale things in a way where we were just implementing good clinical practice that we already knew in a larger way. And that took, just like Michelle said, a huge number of people and resources and people acting outside of their comfort zone to do things that they did not do on a daily basis. Even though it's kind of routine for us, it was all these people coming from other parts of the hospital and other disciplines, and that's borne out even over the course of the last six weeks of people coming from GI or Cardiology or Anesthesia to help us out and take care of these patients and kind of follow our lead on what we know up until today. Even though we still don't know everything.

Prickett [00:17:26] Our ability to share resources, our ability to kind of utilize a system-based approach. It was quite helpful. And again, I think when it brings up the idea of disparities as well. And so we are very blessed on many accounts, but recognize that not everyone has those resources, and how we can help not only the patients under our care, but the community for which we reside and are fundamental members.

Gates [00:17:51] There was a lot of community outreach, which I was very proud of. It was clearly needed community outreach in our own Northwestern community, but also outside of our community to try to protect people and our patients and our patients' families. Lots of videoing like, “Please get the vaccine. I did it. Everybody else do it too!” This has been a very educational experience. But as we probably all can attest, a very emotional experience. There are many different ways as well because we had to process and deal with and adapt to all of those things. So we spent a lot of time talking about the future. And as we move forward, what's something that we're going to take out of this pandemic? What are we walking away with?

Russell [00:18:37] 10 more pounds, I know 10 more pounds, 1,000 more wrinkles.

Prickett [00:18:46] I've got my gray streak. My COVID gray streak. Yes. I mean, for me, it's the acknowledgment of the people in my life that are important and just re-emphasizing that. So it's honestly slowing down a little bit. So I think we've all been go, go, go and trying to do everything for everyone. And it's like, “Well, I need a little me time.” I need a little time to reflect, and I want to do it sometimes with others, sometimes in a big group. Probably not. Sometimes I just need time to myself. But acknowledging that that's important, right? I don't think we always did that before, and COVID gave us, if anything, the time, the space to really show us the important people in our lives.

Gates [00:19:22] I second that, like the importance of family and friends, and also the COVID has forced me to deal with the fact that I am not superwoman and it's OK not to be strong sometimes. And I have to be OK with that because that is true. But big things show you what matters in life, and truly my family and my friends, including you, to carry our friendship forward.

Russell [00:19:45] Yeah, for sure. And then for me, I think learning the importance of taking a break and taking just time for myself occasionally. I'm a travel junkie. And for me, I got a lot of pleasure out of life about planning where my next trip is going to be, experiencing that place wherever it was, preferably somewhere where I'd used a passport, and then coming back and kind of reliving that experience and using that opportunity, usually to reconnect with old friends and have new experiences with friends that I hadn't seen in a long time. And I really miss that. And I think when I had to learn new ways to find that joy in life and of course, family and friends played an important role, but it was also a kind of learning to find joy in myself and take time for myself. It was that was really important.

Gates [00:20:35] Thank you. This has been awesome. As we end this episode, what do we want our listeners to take away?

Russell [00:20:41] Well, part of it, I think, are the things that you'll hear any doctor say, which is more cautiously optimistic, but don't get too comfy just yet. Wear your mask. Be conscious about your activities. If you're sick, do not go out and about in the world. And get vaccinated. Bar none, that's the most important thing that you can do to help healthcare workers, is get yourself vaccinated, get your family vaccinated, prevent yourselves from ending up in the hospital.

Prickett [00:21:10] I would add just grace to yourself and to your healthcare team, and understanding we’re people too. You can talk to us. We're going to give you the best information we have, but some things are evolving. Science is always evolving. And so again, we like to know the science that we have. If we don't have the answers, we’re here to help find it for you, and we understand that everyone has an individual journey. And so kind of reaching out if you do need help and making it specific but really understanding each person's individual, we're all individuals. We all have our additional responsibilities and job titles and roles within the community, and just giving grace to one another and seeing each other for who we are and what we bring to each situation.

Gates [00:21:50] I think that's awesome. I've enjoyed this episode, and I hope our listeners have too.

Russell [00:21:57] Thanks for listening to Get Better.

Gates [00:21:59] We hope you leave this podcast better than when you started.

Prickett [00:22:02] For more information visit nm.org/healthbeat.