Six months later, here’s what treating COVID-19 looks like at Michigan Medicine

Tuesday, September 8, 2020 - 8:10pm

It has been six months since the first COVID-19 case was detected in Michigan.

It has been six months since the first COVID-19 case was detected in Michigan. Buy this photo
Allison Engkvist/Daily

Thursday marks six months since the first positive COVID-19 tests were detected in Michigan. Since then, health care professionals at Michigan Medicine adapted to an unprecedented public health crisis that has tested the strength of the hospital’s resources and employees.

During the first three months of the pandemic, cases in Michigan skyrocketed, reaching a peak of around 1,000 cases on March 30. Health care workers experienced great personal tragedy and loss as a result of the pandemic and said they made it through thanks to the support of colleagues.

For many health care systems across the country, the last six months have also resulted in extreme financial losses — Michigan Medicine is no exception. In May, Marschall Runge, chief executive officer of Michigan Medicine, announced the hospital would begin layoffs and furloughs affecting around 1,400 full-time employees in order to promote the hospital’s economic recovery.

The Daily spoke with five physicians from Michigan Medicine to discuss progress made in treating the disease and the hardships faced by health care professionals over the past six months. 

‘Nobody knew just how contagious this was or how risky it was’

According to Robert Dickson, assistant professor in the Medical School who specializes in pulmonary and critical care, nobody knew the best way to tackle the impending crisis when it first began. 

“A lot of that initial speculation I think was driven by uncertainty and a lack of experience,” Dickson said. “Early on in the COVID crisis we just didn’t have data, we didn’t even have observational cohorts to tell us what we were seeing. So in the absence of that, all you have to go on is personal experience and expert opinion.”

Physicians said the lack of clear evidence and tested treatments created confusion when attempting to help their patients recover from COVID-19. Many said they were working outside of their areas of expertise to treat the disease. 

Hallie Prescott, a pulmonary and critical care physician working in Michigan Medicine’s main Intensive Care Unit and the Ann Arbor Veterans Affairs Medical Center, said a six-month learning curve gradually eased their fears about the virus, and gave time for doctors to determine effective treatments. 

“In the beginning, nobody knew just how contagious this was or how risky it was to be working in these ICUs, so there was a high level of fear about people contracting the virus and among people working outside of their normal scope,” Prescott said. “As we learned more, we increasingly realized that the normal ways that we take care of people in terms of life support were appropriate.”

Since March, physicians around the world have learned about the best ways to treat patients with COVID-19. Various treatments fell in and out of use, including hydroxychloroquine, remdesivir and most recently, corticosteroids. 

Dickson said some of the practices he and other critical care physicians used six months ago are no longer used to combat the virus.

“I think we’re smarter about some of the therapies we offer — there are some things that we were doing back in March and April that had no data to support them,” Dickson said. “One lesson we’ve learned is that nothing competes with the standard, evidence-based practices.”

‘There’s no precedent in my or anyone else’s experience’

Several health care providers expressed pride in their responses to the massive demand for care. Robert Hyzy, medical director of Michigan Medicine’s critical care unit, said neither he nor any of his colleagues anticipated or even fathomed an event like the COVID-19 pandemic.

“As a health care provider, this was a unique experience in my career, nothing even remotely resembles what transpired in the March to May timeframe,” Hyzy said. “There’s no precedent in my or anyone else’s experience as far as I know. Communication was the key to figuring things out on the fly — it did happen and it was terrific.”

Prescott said the crisis demanded creative solutions, like opening the V.A. hospital up to non-veterans for the first time in its history.

“Very quickly the hospitals filled up, so even though this was happening across the world, it doesn’t really become real until you’re hit with it at your own hospital,” Prescott said. “We accepted civilian patients because all the hospitals in Detroit were so overloaded.”

Nursing junior Erinn English said seeing the number of people willing to help treat patients this spring motivated her to continue pursuing nursing as a career.

“Seeing how there’s so much going on, and the fact that we don’t know much about it, it makes me want to be in the role where I can help figure out how we can combat this virus and other diseases that may come into play in the future,” English said. 

Due to rigid restrictions on intensive care unit visitations across the country, thousands of patients have battled COVID-19 alone. Some health care workers said continuing to enforce these restrictions takes a heavy mental toll on patients and health care workers.

“One of the ways that COVID is just cruel is that you have patients, in some cases, dying alone away from their families,” Dickson said. “It’s been a real challenge both professionally and personally to see patients distance from their families at their most vulnerable states.”

Hyzy, who has spent most of the pandemic with critically ill patients, said keeping patients apart from their loved ones becomes morally distressing. 

“These are super sick people and some did die, and to die alone like that is just horrible to bear witness,” Hyzy said. “It was tragic, it just doesn’t sit right with you, and yet it has to be that way when you’re in the middle of a pandemic.”

According to Njira Lugogo, a pulmonary critical care physician and medical director of clinical research at Michigan Medicine, experts have extensively researched the  severity, pathology, manifestations and immune responses of COVID-19 over the last six months.

“Quite a number of faculty members at the University wanted to do trials, to obtain samples from patients with COVID,” Lugogo said. “We worked really hard for several months to create a biorepository for COVID samples, and we had the infrastructure in the clinical research unit.”

‘This is a financial recovery and it’s going to take time’

Sue Bell, assistant professor of nursing and a nurse practitioner, said adequately training nurses for this skillset can take over a year. 

“As we deal with the COVID-19 pandemic, there’s been a huge need for critical care nurses who are highly skilled and have this advanced and complex training to care for critically ill people,” Bell said.

Hyzy said the layoffs and budgets cuts will continue to affect the Michigan Medicine health care system.

“These are real people with real lives who lost their jobs and that’s not a good thing,” Hyzy said. “But this is a financial recovery and it’s going to take time, so this was a very real impact on our system.”

While many states, including Michigan, have begun to reopen sectors of the economy and return to some degree of normalcy, hospitals are still grappling with COVID-19 cases. 

Dickson said Michigan Medicine has yet to go a day without a COVID patient in need of critical care.

“Those of us who are still in the ICU (intensive care unit) caring for these patients feel like COVID never really went away,” Dickson said. “Yes, the numbers we’re seeing are not like we saw in the spring, but we really haven’t had a day in this hospital where we haven’t had someone critically ill potentially dying of COVID.”

According to Jakob McSparron, associate professor at Michigan Medicine specializing in pulmonary diseases, the last six months provided a challenge for health care workers everywhere and exhausted the hospital’s critical resources. However, he said these challenges prepared them for whatever comes next.

“We’d be lying if we said we weren’t tired — I think everybody is exhausted,” McSparron said. “I think we have learned a lot about how to care for these patients and we feel like we can do a better job now.”

Daily Staff Reporter Hannah Mackay can be reached at mackayh@umich.edu.