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UC San Diego Health Sciences

Category: Clinical

— Clinical

For Whom the Pandemic Tolled

A physician who treated hospitalized COVID-19 patients and who experienced the disease herself recalls lessons learned and patients lost

— By Alexandra Rose, MD

In November of 2020, with both the holiday season and pandemic looming, I asked the public to continue wearing masks to protect themselves and to honor their communities, and to honor those working diligently to save the lives of patients infected by the SARS-CoV-2 virus.

I spoke from personal experience, having had COVID-19 myself, fortunately, a mild case, but exhausting nonetheless.

I encouraged families to have difficult conversations while in good health to identify surrogate-decision makers and to consider executing an advanced directive. With the promise of effective vaccines, it seemed like the final push toward the end of a tumultuous era in world history.

Yet through December and January of 2021, some of our worst fears were realized in the unprecedented numbers of critically ill patients admitted with COVID-19, both locally and nationally. A cursory look at COVID-19 hospitalizations suggests these numbers fell dramatically in February and March as vaccination efforts expanded, but lost in translation was the great emotional and societal costs hidden behind these numbers.

As a critical care physician, dealing with death and dying is as much a part of my job as saving lives. Navigating conversations with families when patients fail to improve or progressively worsen is an acquired skill that my colleagues and I work hard to execute with compassion and empathy.

“The majority of hospitalized patients we treated survived. They improved and were discharged from the hospital to continue their recoveries, some at home and some at rehabilitation facilities.”

But many did not, despite the most aggressive forms of intervention, novel therapies and state-of-the-art life support.

There remain significant public misconceptions about the victims of COVID-19. Maybe they were chronically ill or knowingly participated in some risky behavior that lead to their illness, but I can assert with confidence that the vast majority of patients my colleagues and I treated were ordinary people of all ages: parents, children, sisters and brothers, grandparents, hard-working, bread-winning, contributing members of our society. They disproportionately represented minority groups, often from underserved communities. We must work harder to understand this epidemiology and its implications for future pandemics.

We are extremely fortunate that as vaccination rates have risen, we have not replaced many of those lost to COVID-19 with equal numbers of new patients —though we still admit new patients every week. Now, we face a different epidemic: those suffering from chronic critical illness. There are many patients who linger in intensive care units across the country or in long-term acute care hospitals. These patients and their families live in limbo, waiting to see whether the body will heal with more time or ultimately require drastic action, such as a lung transplant. If the worst happens, and they succumb to their disease, we feel this even more acutely, having cared for them and their families often for months on end.

As I write this, the numbers of vaccinated individuals are rising, perhaps to reach the moving benchmark of herd immunity. But there persists a spectrum of hesitancy, which cannot impinge upon maximum
effort to protect those who are vulnerable not by choice, from children not yet eligible to be vaccinated to those with compromised immune systems who may not be able to produce a robust response to vaccination.

For many of us, not just frontline workers, but all of those who have grappled with the demands of work, life, school and childcare throughout the pandemic, a fog of exhaustion persists. Processing the experience of the last year and a half will take time, and there remains much to be learned medically, scientifically and personally. My hope for all is that as we return to some semblance of normalcy, we do so with a renewed sense of gratitude and awe for what we still have and deep reverence for all we have lost.

That, to me, will feel like real progress.

Alexandra Rose, MD is a pulmonary and critical care physician at UC San Diego Health.

— Clinical

You Can’t Go Home

The pandemic brought hospital staff and patients closer together, even as it imposed distance and isolation from family and friends

— By Ruth Perez, RN

I can still recall the moment our unit transitioned from a progressive care unit (PCU) to a COVID-19 unit. It began on a mid-March morning. I kissed my husband and my boys goodbye before leaving home for work, not really knowing how this emerging pandemic would change that morning — and so many mornings after.

During my lunch break on March 11, 2020, I called my husband and said, “This is serious. I think we have to make some adjustments at home for about two weeks until we figure out what is going on with this virus.” The two-week plan would require him to take care of the kids while I stayed in my elderly parents’ garage to avoid any cross-contamination.

“The two-week plan became four weeks, then more. I would not come home again to my family and my own bed for six months.”

My co-workers stepped up to provide me with much-needed support during this difficult transition and time. I have so much respect and admiration for all of my colleagues. Teamwork allowed us to persevere through the pandemic. It was always a group effort: doctors, nurses, clinical care providers, respiratory therapists, physical therapists, occupational therapists, environmental services team members and others.

We needed to be flexible and innovative in how we provided nursing and patient care. We preplanned all of the supplies we would require before stepping into patients’ rooms. As caregivers, we were in rooms for hours: starting IVs, drawing blood, providing medication, passing meals and making sure all of the patient’s necessary activities were completed.
There were moments of distress, frustration and anxiety because policies were constantly changing in response to changing conditions. There were moments of fear when there was talk of a personal protective equipment shortage nationwide. Seeing the large shipping containers of equipment and materials as we prepared for the surge, it seemed like there would be no end to the pandemic.

I still recall a married couple, both admitted for COVID-19. They were initially treated in the Intensive Care Unit. The husband was eventually transferred to my unit. The wife sadly died.

Every morning we would set up his designated iPad so family could communicate with him via Zoom. Initially, we had to hold the iPad for him, but as his health improved, he was able to hold it himself.

Every day he got better. Every day, he would ask about his wife. His family had not yet told him. It was painfully difficult to change the conversation, per his family’s request. They did not want him to become depressed or lose strength knowing she was no longer nearby. They wanted him to get better before telling him that the virus had taken the love of his life. In time, using multiple therapies, he improved enough to go home. It would be a different place, but his story is still one of success and a reason we all worked so hard for so long.

Although I spent more than six months physically separated from my family, I am honored to have been a part of the UC San Diego Medical Center in Hillcrest’s COVID-19 unit. Through the process, I was able to gain knowledge, respect and admiration for my work colleagues, and was humbled by a virus that affected all aspects of our lives.

When emergency use authorizations were granted for the COVID-19 vaccines, I felt a sense of relief. With each shot, I knew we were one step closer to the end of the pandemic.

Of course, the eventual end of one pandemic does not mean the end of all pandemics. There will be others, but I have learned from and leaned upon my co-workers, family and friends, and I know we can meet whatever comes next.

Ruth Perez, RN, is a registered nurse at UC San Diego Health.

— Clinical

Test Driven

Before you can treat COVID-19 — or understand the scope of the health threat — you need to know in whom and where the virus lurks

— By Scott LaFee

In the early days of the pandemic, scientists and physicians struggled just to understand the scope and scale of the looming public health threat. Who was infected? How many? Where?

Answers were scarce, in large part because testing was equally so, and without comprehensive testing data, no one really knew what was happening.

In late-February, the Food and Drug Administration (FDA) debuted guidance permitting university-based hospital labs to develop SARS-CoV-2 diagnostic tests. Steve Gonias, MD, PhD, chief of pathology services for UC San Diego Health and chair of the Department of Pathology at UC San Diego School of Medicine, headed a committee to coordinate lab efforts among the five UC medical centers and later represented those labs in UC’s broader response to the pandemic.

In late March, UC San Diego Health announced it was partnering with five leading in vitro diagnostics manufacturers — Thermo Fischer Scientific, Roche Diagnostics, GenMark Diagnostics, Abbott Diagnostics and Luminex Corporation (the last being a test developed at UC San Diego) — to expand testing capacity. Each manufacturer produced its own testing platform, but none alone could meet UC San Diego’s overall need. In combination, however, they might help weather the coming storm.

Open exam: UC San Diego students are able to conduct self-tests for detecting SARS-CoV-2, following a few simple, illustrated steps.

Ordinarily, said David Pride, MD, PhD, an infectious disease specialist and director of microbiology at the Center for Advanced Laboratory Medicine (CALM) at UC San Diego Health, a single testing platform would be used for sake of consistency.

“We took a diversified approach to meet our patient care needs. Having different platforms means we are able to maintain testing supply, even when one or more manufacturers can’t meet our testing needs,” Pride said.

The goal was to boost testing capacity to 1,000 to 1,500 tests per day within two to three weeks, up from the then-current rate of just a couple dozen tests per day. That ambition was quickly reached. Within six months, CALM had expanded capacity to 6,000 COVID-19 tests daily. Typical turnaround time was reduced to approximately 16 hours.

“In my 17 years as chair of the Department of Pathology, this is perhaps the best example of our pathology lab directors and hospital leaders coming together to accept a challenge on behalf of our entire state and country,” said Gonias. “We succeeded at a high level.”

In April 2020, UC San Diego Health launched serological testing, which looks for the presence of antibodies to the novel coronavirus, evidence that a person has been previously infected, even if they never experienced tell-tale symptoms.

“This is part of the next wave of testing,” said Ronald W. McLawhon, MD, PhD, director of CALM and UC San Diego Clinical Laboratories and chief of the Division of Laboratory and Genomic Medicine. “It’s intended to answer those growing questions about who has been infected and who might still be vulnerable to exposure.”

“We took a diversified approach to meet our patient care needs. Having different platforms means we are able to maintain testing supply…”

— David Pride, MD, PhD

Serological testing was conducted most often in the early months of the pandemic, but less so as vaccination rates increased, with more and more persons possessing antibodies through inoculation.

In May, UC San Diego went live with its own university-based, FDA-approved COVID-19 diagnostic test.

Other UC labs soon followed. On August 31, 2021, UC San Diego Health crossed a milestone, performing its millionth COVID-19 test.

Return
to Learn

A major component to bringing students back to campus and the resumption of in-person instruction was widespread testing, which began with the official launch of the Return to Learn (RTL) program in May 2020.

Testing formally began with on-campus locations providing self-administered, nasal swab-based COVID-19 tests to the approximately 5,000 undergraduate and graduate students who continued to reside on campus, with plans to expand to monthly testing of all 65,000 students, staff and faculty in the fall.

“Asymptomatic testing is important because most of the transmission of the virus is done by people who aren’t having symptoms”

— Robert Schooley, MD

“Asymptomatic testing is important because most of the transmission of the virus is done by people who aren’t having symptoms,” said Robert Schooley, MD, an infectious disease specialist, professor of medicine and one of RTL’s leaders.

“People who do develop symptoms begin to shed virus from the nasopharynx two or three days before those symptoms appear. These individuals feel fine, yet they are shedding larger amounts of the virus at this stage of the illness than after they become ill. This happens because in the beginning stages, the virus turns off the ‘first response’ elements of the immune system. These responses are responsible for the flu-like symptoms we experience in most viral infections. The virus grows unimpeded and leaves us unaware of our infection. This phase of the illness is known as the “pre-symptomatic phase.”

In October 2020, more than 6,000 students moved into dorms, which had been reorganized to incorporate pandemic mitigation measures, such as single-resident rooms. Those numbers expanded with the winter semester and continued to grow, along with the percentage of courses offered in-person.

Throughout, testing has continued unabated, fueled by easy-to-use vending machines that dispense COVID-19 tests, the involvement of the Expedited COVID IdenTification Environment (EXCITE) lab (which in tandem with CALM doubled testing capacity) and other monitoring measures. The tests are free and available to students, staff and faculty.

On September 20, the 2021 Fall Quarter began, with total enrollment exceeding 40,000 students. Of the nearly 12,000 undergraduate students who had moved into campus housing, only 13 tested positive for COVID-19.

Beyond
campus

With time, the ability and capacity of UC San Diego clinicians and scientists to test for COVID-19 expanded dramatically. It was offered in drive-through settings, to persons requiring testing before travel and to other public institutions, such as local schools via the EXCITE lab, who needed an early detection system in order to reopen their own classrooms.

— Clinical

Test Driven

Before you can treat COVID-19 — or understand the scope of the health threat — you need to know in whom and where the virus lurks

— By Michelle Brubaker

When you enter the conference room on the first floor of UC San Diego Medical Center in Hillcrest, it looks like most spaces where meetings are held: A 12-foot-long, walnut-colored table takes up the middle of the room. Chairs and mostly blank walls surround it.

But in emergencies, that room becomes a sort of crisis control center, where experts, highly skilled at operating clinical and non-clinical areas and aspects of the hospital system, convene to sort out issues, make decisions and find remedies. When that happens, phones on the table start ringing constantly. The walls start to fill with pinned notes and broad sheets of butcher paper covered with names, numbers and data. A large, flat-screen TV at one end of the room is turned to local news or video feeds around the hospital. Doctors, nurses, administrators and staff hustle in and out.

The room is transformed. It is now a Hospital Command Center (HCC), a designation activated by events ranging from local wildfires or major power outages to internal issues that might temporarily and significantly disrupt services. It’s a carefully structured operation with specific roles, such as Incident Commander, Safety Officer, Logistics Officer and Public Information Officer, each with its own set of responsibilities.

“We all hung on their every last word, afraid to miss a vital piece of information and hungering to learn more about the novel coronavirus.”

— Yadira Galindo

On February 5, 2020, the HCC was activated for what would become the COVID-19 global pandemic.

Staff across all areas of the hospital system were alerted by their pagers suddenly and loudly pinging. It was their cue to head toward the HCC ASAP, and take their seat at the table.

“What has never ceased to amaze me in the 12 years I’ve had the privilege and honor to be a part of the organization, is that people always come in willing to help, even if they are nervous to step out of their comfort zone,” said Monique Imroth, director of Emergency Management and Business Continuity and Telecom Operator Services at UC San Diego Health.

Carrying the communications pager and on-call, Yadira Galindo, then-senior communications and media relations manager at UC San Diego Health, was among the first staffers to arrive at the HCC that February day.

“There was a frenzy of requests to develop internal and external communications, yet the command center became unnervingly quiet when a member of the infectious disease team gave an update,” said Galindo. “We all hung on their every last word, afraid to miss a vital piece of information and hungering to learn more about the novel coronavirus.” Soon, Galindo was joined by colleague Jeanna Vazquez, who had only joined the communications team a few weeks prior.

“I often found myself going to work and coming home in the dark,” said Vazquez. “The energy walking into that room every day was palpable. We were surrounded by such incredible minds that wanted to help and prepare our staff for this crisis as best as possible.”

“The energy walking into that room every day was palpable. We were surrounded by such incredible minds that wanted to help and prepare our staff for this crisis as best as possible.”

— Jeanna Vazquez

As the hours turned to days, weeks, months and now more than a year, the pandemic has become the longest HCC activation in UC San Diego Health history at more than 650 days, and counting.

“The longest HCC activation prior to the pandemic was seven days during the 2007 San Diego wildfires,” said Imroth.

In the beginning, the HCC was open seven days a week, with some staff members putting in 70- to 90-hour weeks. Daily topics ranged from proper PPE protocols, staffing and training for the COVID-19 units to communicating with Chinese patients airlifted from Wuhan and how to best submit COVID-19 tests to the Centers for Disease Control in Atlanta for processing.

People who had never been part of an HCC were tapped. “We were using our collective knowledge, skills, abilities, talents, desires and efforts to synergize and band together,” said Imroth.

There was also a fear factor. “The command center sits in the hospital setting. People were wondering if they were going to catch the virus and bring it home to their families.

“Part of my job is to connect with everyone in that room and let them know I am there for them. If I found out someone in the HCC liked peanut M&Ms or had a dietary requirement or drink preference, we made sure to provide those comforts. If I knew someone was feeling uneasy, I shared my own feelings with them. I am a fan of candid conversation, and sometimes humor, to eliminate anxiety and let others know they are not alone. And during that time, we all needed to know we were not alone.”

As more was learned about the novel coronavirus and COVID-19, and guidelines emerged and evolved regarding masking, physical distancing and reducing transmission risks, HCC operations settled into a sort of routine. After seven months working around that conference room table, and realizing that the pandemic was not going to end any time soon, the decision was made to go remote. It had never been done before for a major crisis event.

“We transitioned to a virtual command center slowly. It was similar to the physical command center in that we still had a plethora of meetings and briefings. We just did them over Zoom instead of from across a table,” said Imroth. “As things changed with the pandemic, we adapted too.”

The virtual HCC continues, with weekly briefings for key leaders and occasional sessions as needed. Hundreds of all-staff emails have been sent, updating employees to the situation and needs.

Recalling 2020, Imroth said some lessons carry forward.
“I think what we found out is that we need each other.
We need each other to get through these difficult times.
We need each other as cheerleaders.
We need each other as support teams.
We need each other to laugh with.
We need each other to cry with.
We need each other to rant with.
We need each other.”

Happy Orange

On the morning of February 5, 2020, with the first potential COVID-19 patients en route to UC San Diego Medical Center in Hillcrest from quarantine at Marine Corps Air Station (MCAS), a Code Orange was called.

— Clinical

Test Driven

Before you can treat COVID-19 — or understand the scope of the health threat — you need to know in whom and where the virus lurks

— By Jeanna Vazquez

For refugees living in San Diego, the challenges caused by a global pandemic were magnified in a city they had just begun to call home. In response, the UC San Diego Refugee Health Unit shifted its focus to supporting members of communities experiencing systemic inequities exacerbated by the public health crisis. Work began with a survey of the San Diego refugee community, the first in more than 15 years.

Surveyors learned that nearly one-third of families had canceled or missed health appointments during the pandemic. In more than 40 percent of surveyed families, at least one member had lost their job; 60 percent of families couldn’t pay rent and feared they would be evicted.

“For us, our work is more about looking at the issue of systemic racism and tackling that,” said Amina Sheik Mohamed, founding director of the Refugee Health Unit.

“The energy walking into that room every day was palpable. We were surrounded by such incredible minds that wanted to help and prepare our staff for this crisis as best as possible.”

— Jeanna Vazquez

“Right now we’re figuring out where the gaps are to meet the community where they are. With our approach, we collect information on what is needed, how to get these resources to the community and then we go to the next problem. We’re climbing the ladder together. It’s not one group, but all of us, and it’s something to be proud of.”

After the survey, the Refugee Health Unit served as a conduit between the refugee community and the County of San Diego by holding meetings with community health care workers and local government officials.

“We received weekly updates from the county on the pandemic, including vaccine eligibility and tier restrictions, and then took those updates back to our community health care workers who disseminated the information to refugee community members,” said Reem Zubaidi, manager of the Refugee Health Unit. “This was essential to the whole process. We can’t understate how important it is to provide this information in a person’s primary language from someone who they can relate to and converse with in their preferred communications method. It’s not just translation, it’s cultural.”

— Clinical

Test Driven

Before you can treat COVID-19 — or understand the scope of the health threat — you need to know in whom and where the virus lurks

— By Michelle Brubaker

In 2020, Brenda Tanoi lost one or two family members or friends each month to COVID-19. In December 2020, the 68-year-old Logan Heights resident and retired educator from American Samoa was infected herself with the virus.

On the day in mid-April 2021 when these photos were taken, Tanoi was at home, still recovering from her bout with COVID-19 and awaiting her second shot of the Moderna vaccine and a dose of hope from a nurse practitioner with UC San Diego Health’s Population Health Services Organization (PHSO).

“The energy walking into that room every day was palpable. We were surrounded by such incredible minds that wanted to help and prepare our staff for this crisis as best as possible.”

— Jeanna Vazquez

Open exam: UC San Diego students are able to conduct self-tests for detecting SARS-CoV-2, following a few simple, illustrated steps.

Early in the pandemic, PHSO brought together staff in social work, nursing and pharmacy to anticipate the physical and emotional needs of high-risk seniors, those age 65 and older. The effort included a call center where staff answered questions, triaged needs, provided vaccine education and sometimes just offered a compassionate ear. Ten team members work the phones, handling approximately 10 to 15 calls each, daily.

PHSO’s at-home service took center stage during COVID-19 vaccinations. Staff could reach out to senior patients whose health prevented them from traveling to a vaccination site. As of May 2021, there have been more than 1,000 home visits. “We try to make doing the right thing the easy thing for our elderly patients, helping them get through this marathon,” said Ming Tai-Seale, PhD, director of research and learning at PHSO.

In her visit, Tanoi gratefully and joyfully welcomed visiting nurse practitioner Janet Davis. “I am honored to tell everyone I am fully vaccinated,” Tanoi said. “I want to stop going to memorial services. I want to enjoy many more birthdays and holidays with my family, for as long as I can.”

Back to Articles

— A Letter from
Patricia S. Maysent

Amid Tears and Fears, determination, hope and unity of purpose

I remember when I got the initial phone call from the County inquiring if UC San Diego Health would take in the first patients flying out of Wuhan, China to San Diego.

At the time, all we knew was that Wuhan was ground zero for a spreading, previously unknown viral infection. People were dying and there was no existing medical literature, nor any test, for the virus that would be called SARS-CoV-2.

Nonetheless, Marine Corps Air Station Miramar would soon receive a military plane containing multiple Wuhan evacuees; some of whom were possibly infected by the mysterious coronavirus.

Knowing our advanced capabilities as an academic medical center, particularly in the relevant areas of infection prevention and control, public health and respiratory disease, it was actually an easy decision. “This is what we are meant to do,” I thought.

We quickly opened our Hospital Command Center (HCC) and mobilized. Typically, an HCC event lasts roughly a week, maybe two. In this case, weeks became months, then months became more than a year. Time blurred. Zoom calls and masking became as routine and commonplace as handwashing. It would be 412 days between our first case of COVID-19 and the first day when we recorded no new infections.

The pandemic has been the most extraordinary event of my career, and likely for many others. Every single employee of UC San Diego Health was impacted, from custodians, nurses and nutritionists to supply chain managers, screeners, administrators and physicians. Everyone played a role in slowing or stopping the virus and saving lives.

We worked the same hours as COVID-19, which was constantly, day and night, weekends too. It was a coordinated effort of monumental proportions that led to formations of new teams and new levels of trust and innovation that propelled us forward, out of fear and into a new normal.

I cannot write about the pandemic without acknowledging those who died from the virus and whose families were devastated by the loss of loved ones. These tragedies happened disproportionately in many of our underserved and under-reached communities, a historical condition and injustice that shall remain a focus of UC San Diego Health, even as COVID-19 hopefully recedes into the background and our memories.

I’m often asked what about our response I am most proud. There is no single answer. We were first in the region to treat patients with COVID-19; first to open vaccine clinical trials; first to offer a mobile ECMO (extracorporeal membrane oxygenation), a type of machine that pumps and oxygenates a patient’s blood outside the body; first to vaccinate our employees and first to open a vaccination superstation to the public.

We led the way on CA Notify, a mobile solution to identify new exposures of COVID-19 in the community and state. Our nurses and specialists travelled to other hospitals in the United States and Mexico to teach new lessons and insights in the art of critical care; they returned to help vaccinate too. What all of these achievements have in common are unbounded compassion, brilliance and determination that characterizes the people of UC San Diego Health.

For every article in this magazine, I know there were hundreds more unwritten that could tell story of bravery, drive and connectedness during the pandemic. I thank all of my team members for their selfless contributions. I am so very proud of you and grateful for your service and kindness.

I would also like to express a deep and sincere gratitude to our donors, who stepped up at the same time to help us meet so many challenges. Their contributions of time and funding helped us rapidly expand and sustain our efforts to build testing capacity, acquire ventilators and surge supplies and launch multidisciplinary research efforts into new diagnostics, therapies and ways to monitor the virus. Their generosity saved lives and will help us in the future.

With lessons learned, I believe we move forward together, unified, a better and stronger organization.

Sincerely, Signature of Patricia A. Maysent Patricia A. Maysent Chief Executive Officer, UC San Diego Health

December 10, 2021

— Clinical

It began with seven tea kettles

Frontline staff at UC San Diego Health recollect the first days of the pandemic, a time marked by fear, uncertainty and endless acts of kindness

By Michelle Brubaker, Jackie Carr and Jeanna Vazquez

On a cold morning in February, seven stainless steel electric tea kettles, filled with hot water, are delivered to patients’ rooms at UC San Diego Health Medical Center in Hillcrest. The tea kettles are not typical, but neither are the times.

The COVID-19 pandemic had begun in earnest, and the kettles represented an early act of comfort and humanity in a time that would soon demand an outpouring of both.

On February 5, 2020, UC San Diego Health activated the organization’s Hospital Command Center (HCC), the central location where in-house experts gather to develop and implement a response to an emergent and urgent situation. In this case, it was the growing crisis surrounding the novel coronavirus, SARS-CoV-2, then rapidly spreading in Wuhan, China.

Five days later, UC San Diego Health received its first patient with diagnosed COVID-19, an evacuee from Wuhan, who had previously been airlifted to and quarantined at Marine Corps Air Station (MCAS). The patient was officially the 13th case of COVID-19 in the United States and would soon be followed by others from MCAS.

They arrived via ambulance, escorted by law enforcement vehicles and greeted by medical staff, security officers and officials from the Centers for Disease Control (CDC), all wearing masks, face shields, gloves and other personal protective equipment (PPE).

Seven new tea kettles were purchased, filled with hot water and served with sides of lemon and ginger to the first patients from Wuhan.

There were more questions than answers

The virus was largely unknown, as was the plan of treatment. There were more questions than answers.

“One question raised in the HCC was ‘Does anyone here speak Mandarin?’” recalled Lily Angelocci, transformational health care lead coach at UC San Diego Health. “From there, I spent the next two weeks at the bedside of the patients in our intensive care unit, helping to meet their physical and emotional needs.”

Four evacuees were eventually transferred from MCAS to UC San Diego Health for care. Most spoke little or no English. Translators were found.

Angelocci was always nearby, intent on addressing their physical needs or easing their emotional concerns. It wasn’t yet clear who was infected with the SARS-CoV-2 virus and who was not, but all of the patients were far away from home, away from loved ones and afraid of a disease no one yet understood.

“At the time, we had to wait days to receive test results from the CDC in Atlanta to confirm if the patients from Wuhan were actually positive with the virus,” said Angelocci. Two were.

“What initially struck me was the delicate humanity of the situation,” said Francesca Torriani, MD, program director of Infection Prevention and Clinical Epidemiology at UC San Diego Health. “In the patients’ faces, I could simultaneously see fear and gratitude: fear of rejection and gratitude for us accepting and welcoming them.

“Can you imagine being evacuated from Wuhan on a windowless airplane, not knowing if you had the virus, or if you would live or die; of being targeted because of bringing a new disease into a country? My heart went out to them.”

Even with the language barrier, the patients’ concerns and fears soon became apparent.

Comfort Food

“We realized that they were not eating,” said Jill Martin, director of food and nutritional services at UC San Diego Health. “We needed to devise a plan to make sure these patients were fed and felt supported. Our role is not just to provide food on a tray. Providing healthy meals is a significant part of the recovery process. That was our main priority.”

Many of the patients could not digest certain foods being offered.
With assistance from Angelocci, Martin’s team visited specialty grocery stores to purchase more familiar fare. It brought patients and staff closer together. “One of our chefs, Bo-Kai Liao, speaks Mandarin and was integral in those early days, making sure there was a strong line of communication. He would call the patients in their rooms several times a day, find out about their food preferences and customize their meals,” said Martin.
Favorites were wonton soup, egg and seaweed soup, congee (a type of rice porridge), spicy Mapo tofu and a Taiwanese basil omelet.

Meals were served using only disposable materials, to reduce the risk of virus transmission. Some foods, such as meats, were cut into bite-sized portions in the kitchen before delivery.

“We are all human, but different things comfort and heal us,” said Martin.

“We found a balance of caring for these patients while still following all the safety measures.”

“Normally, loved ones are in the rooms to help with the meals, but that was not the case for these patients. Sometimes, patients were too weak to cut their own food, so we did that for them to make sure we were doing everything we could to help them eat and heal.”

The seven tea kettles were part of that process.

“In Chinese tradition, they do not drink cold or room temperature water, only hot water. In talking with the patients, we realized they were being served cold water,” said Angelocci.Tea kettles were purchased. Patients soon received their water hot, served with sides of lemon and ginger. Patient Experience staff added to the efforts, delivering floral arrangements to brighten up rooms and power cords, chargers and coloring books to help patients stay connected to the outside world and pass the time.

“We always teach our staff one word: the Japanese term, ‘gemba’,” said Angelocci.

“It means ‘the place where value is created.’ In practical terms,” said Angelocci, “it means to ‘see, show respect, and ask why.’ It meant the world to patients and staff.”

“We needed to devise a plan to make sure these patients were fed and felt supported. Our role is not just to provide food on a tray. Providing healthy meals is a significant part of the recovery process. That was our main priority.”

— Jill Martin

Kevin Kwak, MD,
was among the first doctors to see and treat patients from Wuhan, China.

Counceling Patients

The unpredictable nature of COVID-19 first struck Kevin Kwak, MD, a hospitalist at UC San Diego Health, when he walked into the room of a 30-something patient with the disease.

“When I had seen the patient earlier in the day, he seemed stable overall. He did have some shortness of breath, but he was able to communicate. Later that evening, he was on six to seven liters of oxygen,” said Kwak.

“Seeing a patient decline like that in only about 12 hours was eye-opening. He did have some co-morbidities, but that moment stands out as when I truly realized how serious this virus is, and that it does not discriminate.”

Kwak was among the first health care workers on the scene when patients from Wuhan were admitted to a dedicated, isolated COVID-19 unit at UC San Diego Medical Center in Hillcrest.
The unit was the product of multiple departments collaborating, and was staffed by physicians and nurses who volunteered to care for the patients.

“I remember that night vividly,” said Kwak. “I was asked if I would be willing to take care of the patients coming from MCAS because we were not sure of the associated risks. I am relatively young. I am healthy. I live alone. I quickly answered yes. It was definitely something I wanted to do.”

“There were so many uncertainties at that time, but we were all incredibly focused while collaborating, coordinating and communicating.”

— Kevin Kwak, MD

Collaboration, Communication, Coordination

He said most of the Wuhan patients’ symptoms were mild, but he spent considerable time trying to alleviate their uneasiness.

“As physicians, we were still learning about the trajectory of the virus. We were trying to address the patients’ questions, even though we didn’t know all the answers. The main questions were: Am I going to be okay? When will I be able to go home? I could only tell them with confidence that we were working around the clock to provide the highest quality of care. We were gathering as much information as possible and adapting.”

All of the Wuhan patients were discharged a week or so after admittance to continue their recoveries with family and friends. By then, however, COVID-19 cases were appearing among local residents. At Hillcrest and Jacobs Medical Center in La Jolla, long-term COVID-19 units were set up for patients from the San Diego community.

“Back in February 2020, all we knew about the virus was that it was respiratory, but we weren’t sure how it was being transmitted,” said Dante Segundo, RN, MSN, nurse manager at UC San Diego Health.

The rising number of local cases prompted massive organizational changes.

“We transitioned from a relatively contained situation with the patients from Wuhan to one that was now affecting the community at large. Our entire hospital system had to pivot.”

Processes, from testing and treatment plans to managing huge volumes of lab work, were refined daily, often spurred by evolving CDC guidelines.

“We were all learning about the swab tests, waiting three to four days for test results (from the CDC in Atlanta) and understanding what PPE we should be wearing,” said Kwak. “There were so many uncertainties at that time, but we were all incredibly focused while collaborating, coordinating and communicating.”

It Takes a Medical Center

Conquering COVID-19 required a team effort, from university researchers to practicing physicians, nurses and the staff that keep hospitals functioning.

“I must give credit to the pulmonary critical care group for the daily care and management of the patients. I saw how their team, under the leadership of Dr. Jess Mandel, fine-tuned the treatments and turned the care of patients with COVID-19 into an art,” said Torriani.

“Based on their observations, they developed strategies for steroid use, ventilation management and other necessary lifesaving interventions that were eventually taught to other hospitals in the United States and Mexico.”

In the beginning, only physicians and nurses were permitted inside rooms with COVID-19 patients. It was a matter of prudence and safety, but it also “provided the opportunity to work closely together, which strengthened our working relationship during such a stressful moment in time,” said Segundo.

“It was all hands on deck,” added Kwak. “We were all in the same boat, learning about this disease together. We were supporting each other and had a deep understanding of what we were all going

through and feeling. We were holding each other up through all of the exhaustion. We became like family during this time, and those strong relationships remain.”

COVID-19 changed work streams throughout the hospital. It impacted the hospital’s Environmental Services Department (EVS), who needed to assess and revise cleaning and disinfection protocols.

It Was All Hands On Deck

There was a steep learning curve when the first patients arrived from MCAS Miramar, and initially Environmental Services (EVS) staff did not clean the rooms when patients were to avoid any unintentional contraction of the virus. Instead, nursing staff kept patient rooms clean; EVS crews prepared rooms before and after patients were admitted or discharged. When community spread surged in April 2020, EVS teams transitioned to cleaning rooms with patients to better support over-taxed nurses and doctors.

Throughout the pandemic, Segundo said the tripartite mission of UC San Diego Health — outstanding patient care, groundbreaking research and inspired teaching — was tested, but rose to the challenge.

“As an academic medical center, we had patient care, research and education all happening in one space at the same time. That idea of lifelong learning was an everyday normality for our unit,” Segundo said. “I’m most proud of our resilience. We found ways to be joyful, caring and critical thinkers all at the same time.”

“It was all-hands-on-deck. We were all in the same boat, learning about this disease together. We were supporting each other and had a deep understanding of what we were all going through and feeling.”

— Kevin Kwak, MD

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