A Year with Covid
A Conversation with St. Clair Hospital’s CMO
ust like when a soldier goes off to war, a major event may make someone think about their mortality and make certain preparations—redo the will, make sure life insurance is lined up, write messages to friends and family. When the COVID-19 pandemic hit in March 2020, and medical personnel continued going to work every day to fight a little-known enemy while the rest of the world hunkered down, Dr. John Sullivan’s wife, Barbara, started writing letters to their children.
“I was trying to put together why she was feeling that way about it. And then I realized, she was preparing to deploy,” said Dr. Sullivan, a Navy veteran who is senior vice president and chief medical officer of St. Clair Hospital. He and his wife are both anesthesiologists, a job which, in the beginning of the pandemic, was considered extremely high-risk.
“It turned out, in reality, that the protective equipment we wear provided enough safety. Even in high-risk jobs,” says Dr. Sullivan. This is one of many lessons learned at St. Clair Hospital and beyond as the world adapted to COVID-19.
In Dr. Sullivan’s role, he assumed responsibility for many of the logistics of St. Clair Hospital’s response to the pandemic. The medical decision-making fell to the hospital’s infectious disease specialists, led by Chief of Infectious Disease Dr. Stephen Colodny, while Dr. Sullivan implemented strategies to build testing supply, design protocols and keep the staff and patients safe.
“We were writing protocols and rewriting them on an hourly basis at times,” said Dr. Sullivan.
Because the virus was new—and almost completely unstudied—in the beginning, St. Clair Hospital relied heavily on their partnership with the Mayo Clinic. The plethora of resources available to a large distinguished academic medical center like the Mayo Clinic allowed St. Clair Hospital leaders to make decisions with the confidence that they were using the best and most complete information available, in spite of all the uncertainty.
For example, in April, St. Clair Hospital enrolled in the Mayo Clinic convalescent plasma trial to begin utilizing plasma donations from the Pittsburgh Central Blood Bank to provide a dose of antibodies to critically ill patients.
The Mayo Clinic also conducted a large portion of St. Clair Hospital’s COVID-19 tests, particularly during the first months of the lockdown. St. Clair Hospital has since built three in-house COVID testing platforms, but they continue to utilize the Mayo Clinic reference lab.
“When people ask for examples of the advantages of partnering with the Mayo Clinic, I go right to COVID. There is no greater demonstration of their value,” said Dr. Sullivan.
St. Clair Hospital’s partnership with the Mayo Clinic began in 2017, bringing the Mayo Clinic Care Network to the Pittsburgh region.
Dr. Sullivan also touts the value of a new, and perhaps unexpected, partnership that formed between the major hospital systems in the region, including UPMC, Allegheny Health Network, Butler Health System, Heritage Valley Health System, Excela Health and Washington Health System. In March 2020, hospital leaders put competition aside and began sharing resources to help control the spread of the virus in Pittsburgh. These meetings are now a weekly occurrence, and Dr. Debra Bogen, Director of the Allegheny County Health Department, often leads the calls.
“She’s making the tough decisions on mitigation measures and is under an intense amount of political and public pressure … She often reminds us ‘Anything I do will take three weeks to affect hospital censuses. If you get overwhelmed, I need to know sooner rather than later,’” Dr. Sullivan said.
An example of the type of issue covered in these weekly sessions comes from a meeting in January 2021, when this story was written. The issue at hand was, “How are we going to handle COVID exposures in staff members who have already been vaccinated?” Each person developed a plan individually, and when they brought them to the table, the answer wound up being the same across the board: If the person in question is two weeks post-vaccination, their risk of infection is low. So as long as they wear their protective equipment and watch carefully for symptoms, they can continue to work.
“There was no precedent, so we relied on each other,” said Dr. Sullivan. “It’s funny. We’ve only interacted one time in-person at a press conference … but these people have become closer colleagues to me than anybody. And after nine months of this, I’ve barely laid eyes on them.”
One of the reasons all the hospitals in the region have been able to work together so successfully is because, generally, the virus has trended the same in each place.
Over the summer of 2020, an alarming trend across the county was a decrease in patients coming in for important routine tests. “If people are afraid to come in and get mammograms and colonoscopies—where earlier diagnosis is clearly linked with better outcomes—we were thinking we could potentially start to see more deaths and adverse health outcomes from that,” said Dr. Sullivan. “But COVID took so many lives this fall and winter, it’s hard to say. For COVID, minutes and hours are meaningful. For cancer, it’s months and years.”
As a result, hospitals focused on refining sanitation protocols to build patient trust. St. Clair hospital was the first medical center in the area to implement Nanowave technology devices in its waiting rooms in December 2020, which reduce virus particles in the air.
The timing was perfect, as late November into early December is when Allegheny County case counts reached their peak. At St. Clair Hospital, a 329-bed facility, Dr. Sullivan instituted a five-phase plan to deal with the surge by assigning more ICU and non-ICU beds to COVID patients. Hospitals, including St. Clair, started adding COVID wards to accommodate the need, and each felt a significant hit to their work force as medical staff became exposed.
“In the beginning, we expected having to manage challenges of patient-to-staff or staff-to-patient transfer of COVID, but in all this time, I’ve only seen one instance where that occurred,” said Dr. Sullivan. “People got COVID in our community and in our workforce, but almost all of it was from household contacts and community contacts … (medical staff) are more likely to catch COVID when they leave on break … I’m really proud that we’ve kept our health force safe and healthy.”
Now, as we approach one year of dealing with COVID and with much of St. Clair Hospital’s workforce receiving both doses of the Pfizer vaccine back in January, 2021, the mood at St. Clair has changed. Dr. Sullivan recalls, when the pandemic first hit, personally thanking the weary nurses in the COVID ward for all that they have done to power through their own fears and support patients medically and emotionally, as they battled the disease without their friends or family by their side.
Even if they weren’t assigned directly to the COVID ward, in March and April a vast majority of the staff was somehow assisting with the COVID-19 effort. Rather than furlough workers who normally would have been assigned to non-emergency surgeries, St. Clair Hospital opted to implement a job-sharing system to keep all 2,500 workers employed.
“The early days of this pandemic was this first time in several decades where health care workers had to be concerned with their own health. It has not been since the ‘80s, with HIV, where you thought ‘if I accidentally stick myself with a needle, it could be lethal.’ There’s an entire generation trained in healthcare that never faced that,” said Sullivan.
Time has shown that personal protective equipment is effective, but the vaccine is the final step to ensuring that medical personnel feel completely safe again.
However, the pandemic is far from over. The majority of the general public still has yet to receive the vaccine. At press time, St. Clair Hospital was waiting on updates from the county and state before releasing information on how they plan to help bring the vaccine to the community. Check www.stclair.org for up-to-date information.
In the meantime, Dr. Sullivan’s advice?
“It really comes down to masks. Simply masks. Not even those N95s that were in such short supply early on. Just simple surgical masks and face masks will wind up being what kept us safe.”