"I am proud of our ICU teams in how they've provided excellent clinical care to COVID-19 patients during these challenging times," says Dr. Sara Auld.
Sara Auld, MD, MSc, Assistant Professor, Emory University School of Medicine and Rollins School of Public Health, and Georgia Clinical & Translational Science Alliance (Georgia CTSA) Master in Science in Clinical Research (MSCR) graduate, has helped her team develop best practices and guidelines for ICU patients at Emory University Hospital Midtown who have COVID-19.
“While I was attending in the ICU in the middle of March during the week that COVID hit, we transitioned from being a traditional medical intensive care unit to a COVID unit. There were many concerns because we were dealing with a disease that we didn’t have previous experience treating. When you layer that on top of the PPE and infection control issues, it was a period of adjustment for the team,” comments Dr. Auld. “We addressed that by focusing on our communication and coming together at least once, if not twice a day, with everyone in the ICU - the physicians, nurse practitioners, physician's assistants, residents, nurses, and medical assistants. We wanted to make sure everyone felt like their concerns were being addressed and their questions were answered. Over the past month, the sense of anxiety has declined, which means our staff is getting more accustomed to clinical care at the time of COVID. People have gotten into a rhythm with their PPE, getting in and out of the rooms, and the time it takes to do the additional steps that are needed to ensure safety for everyone.”
These ICU providers usually take care of patients with diseases that they have been accustomed to seeing that they learned about when they went to medical school since practitioners have been treating those diseases for decades. With COVID-19, it is an entirely new disease. While the providers know how to provide supportive care for patients who are on a ventilator, COVID-19 is behaving in different ways than most of the respiratory viruses. COVID-19 causes an intense inflammatory reaction in the body in some patients which also needs to be managed.
“I was attending on service when we admitted our first COVID patient and helped open our COVID ICU at Emory Midtown which was one of Emory’s first two COVID ICU units. Those of us who were attending in those early weeks were enlisted to help create guidelines and best practices for our ICU patients who have COVID. We created a best practices group to pull together what we're seeing in the literature and what we're seeing in our ICUs,” remarks Auld. “We’re also talking with colleagues from other institutions who can help us gain perspective for how we may need to modify what we usually do now that we’re in the setting of COVID where things are going to be different. For example, we've seen that COVID can lead to much higher rates of blood clots than we're used to seeing in our ICU patients, so we're investigating possible causes. Even as we are learning more, we are also developing recommendations for how to prevent those blood clots which in some cases can be fatal.”
Auld adds, “Even though early reports are coming out of the experience from China, the West coast and a few from the Northeast, many are early anecdotal reports. We're learning as we go, which is contrary to the evidence-based medicine practice that we've learned through our training. We've been taught not to react to anecdote and personal experience, but rather to rely on an evidence base that is generated from well-conducted randomized controlled trials with a thoughtful and systematic review of the literature so that, we're not relying on hunch and instinct, but what has been well proven over many years. Here we simply don't have that evidence base. So, it's this tension of not wanting to overreact to these anecdotes and one-off clinical situations that we're seeing, but also not wanting to underreact to them either.”
Knowing the COVID ICU teams across Emory Healthcare needed to start generating the evidence base in real-time, Dr. Auld says, “There's been this amazing effort that's a collaboration with our colleagues in critical care and Dr. Jim Blum, Vice Chair for Clinical Research in Emory’s Biomedical Informatics department, along with some of our phenomenal ID fellows. We've created a research collaborative. For all of the patients admitted to the ICU, we’re gathering their clinical data in real-time. We have a team of residents helping us to go through the charts and pull out those details from the charts that aren't easy to get from their electronic medical records. Starting this week, we’re using that data to conduct formal analysis and understand what are the risk factors for people having poor outcomes from COVID disease. This knowledge will inform us locally and day-to-day how we go about our practice and how we understand how best to take care of these patients. There will also be publications we will disseminate to national and international audiences.”
“Having the background from the MSCR program to think about how to set up a database and the appropriate analysis for this kind of situation is incredibly relevant. For example, we've already established a team to work on a case-control study to identify who's had blood clots and who hasn't. We aim to identify risk factors to help us predict who is at higher risk and determine how we can manage those people more aggressively.”
The Emory Master of Science in Clinical Research (MSCR) degree program, in the Laney Graduate School at Emory University, provides innovative didactic and mentored research training to those interested in pursuing a career in clinical and/or translational research. The MSCR degree is designed for predoctoral, postdoctoral trainees, and junior faculty from Emory, Morehouse School of Medicine, Georgia Tech and UGA.
The Georgia CTSA is a statewide partnership between Emory, MSM, Georgia Tech, and UGA and is one of over 60 in a national consortium striving to improve the way biomedical research is conducted across the country. The consortium, funded through the National Center for Advancing Translational Sciences (NCATS) and the National Institutes of Health's Clinical and Translational Science Awards, shares a common vision to translate laboratory discoveries into treatments for patients, engage communities in clinical research efforts, and train the next generation of clinical investigators. For more information, visit GeorgiaCTSA.org.