Dept COVID-19 Update

Colleagues,

I wanted to update you on a few departmental and institutional activities, and to also express my gratitude for your generous and diligent support of one another and the needs of our patients.

PPE: A number of you have expressed legitimate concern about the restricted availability of PPE, particularly masks, beyond those healthcare workers with direct care responsibilities of COVID 19 confirmed or suspected cases. N95 masks for the ED personnel have recently been made available since they are at high risk. The rationale for making the difficult choice of not distributing masks to everyone include the following: this practice is not currently recommended by CDC and our ID advisors did not believe it was likely to be helpful; since our PPE supply, including masks is limited, conserving available supplies to avoid situations where we don't have sufficient PPE for high risk exposures is a priority. Partners decided to take that chance, we (and other health systems in Boston) did not; I was on a call yesterday with about 25 chairs of medicine-none of their institutions had gone to the full mask policy that Partners implemented. The rationale was the same as ours. The current policy is subject to ongoing revision as the PPE supply becomes clearer. I also wish we had enough masks for everyone but believe that BMC leadership made the correct decision under the circumstances. As to the approach for individuals wearing masks against policy, we decided against requiring staff to remove them despite the unintended message that selective wearing of masks may send. Major efforts are underway to address the PPE supply problem for the institution.

Staffing: Thanks to the hard work of our inpatient COVID teams, led by James Hudspeth, a contingency plan for the anticipated surge in COVID-infected patients is being developed. Our residents and faculty have been remarkably generous in providing coverage, volunteering for service, and supporting one another. The ICU and hospitalist attendings have been particularly effective and supportive in insuring the quality of care and in supervising our hard-working residents! BMC leadership has also been working diligently to expand our potential Med Surg and ICU capacity should the need arise. I anticipate that we will need to extend staffing beyond the usual inpatient medicine and intensive care attending and resident pools if the more extreme surge scenarios occur.

Financial Impact: The financial consequences of the COVID 19 epidemic are obviously being felt across all sectors of the economy, but particularly in the health care industry. The scale of impact across the country is so large that it seems highly likely that there will be some form of government support for the industry. BMC and our department are beginning to experience what is anticipated to be a sharp decline in clinical revenue. In addition, the distribution of clinical work across our department is highly variable-we have some clinicians who are working beyond their usual schedule under very stressful conditions and others who are under-utilized, particularly in the outpatient and procedural areas. It is critically important that we have a thoughtful, responsible, and fair approach to meeting the inevitable financial challenges before us. Therefore, we are forming a committee to develop a set of principles to maximize our ability to support our faculty and staff, and to secure the long-term future of the department. We hope to formulate a plan in the next few weeks. Meanwhile, BMC is seeking permission from the Board of Trustees to implement a furlough plan for BMC employees that seeks to offer some protection for the impacted employees while meeting the financial constraints of the institution.

Communication: The social isolation that we are experiencing is quite daunting. I have been reminded of how meaningful the social interactions are in my own professional life. I do hope to join with you in finding new ways to stay connected. I will hold a departmental faculty meeting via Zoom in the next few days. I encourage each of your sections to continue as many educational activities as possible during this period as well. Please offer any suggestions for how we can improve our communications in the department!

As we endure this unprecedented period of disruption in our personal and professional lives, I am inspired by your kindness and commitment to the noblest values of our profession. Thank you for your forbearance and for working so hard on behalf of our patients and one another. Our department will emerge from this experience wiser, appreciative, and fully prepared to soar into the future!

David Coleman, M.D.