Huskies fighting COVID-19: Lisa Chew, Martine Pierre-Louis and Paula Houston

This week we connected with Dr. Lisa Chew, Associate Medical Director of Ambulatory Services at Harborview Medical Center and associate professor at the UW School of Medicine; Martine Pierre-Louis, Director of Equity, Diversity and Inclusion for Harborview Medical Center; and Paula Houston, Chief Equity Officer for UW Medicine and Associate Vice President for Medical Affairs at the UW. Together, they spearheaded the creation of multiple mobile vans to provide COVID-19 testing in underserved communities.

Q: Could you tell me a little bit about each of your roles and how you three know each other? Had you worked together before this project?

LC: I provide clinical leadership, direction and oversight of ambulatory care services at Harborview Medical Center. My focus is on the design, implementation and operations of programs that promote high quality, safe, equitable and cost-effective medical care. I am dedicated to improving the delivery of care for underserved populations and currently chair the Harborview’s Equity, Diversity, and Inclusion Council — with Martine Pierre-Louis — to integrate efforts to address disparities and advance equity at Harborview Medical Center.

MPL: As Director of Equity, Diversity and Inclusion, my role is to identify, define, assess and make recommendations on the implementation of policies, practices and processes that promote health equity and workforce diversity and inclusion at Harborview. As part of this role, I connect with community partners in order to make their experiences and voices an integral part of the planning, designing, delivery and evaluation of our services.

PH: In my role, I am leading the work to advance equity, diversity and inclusion across the UW Medicine system as we strive to become an anti-racist organization. Our work is focused on policies, practices, education and training within three objectives set forth in our Healthcare Equity Blueprint – Workforce and students, community engagement and clinical improvements.

LC: Paula, Martine and I have worked together on issues related to equity, diversity, and inclusion at UW Medicine.

Q: How did the idea for the mobile testing vans come about?

LC: Early in the pandemic, we noticed that the majority of the patients hospitalized for COVID-19 at Harborview Medical Center were limited English proficient. We wondered if this finding held true more broadly. When we looked at data across UW Medicine during the month of March, we found that limited English proficient individuals and persons of color had much higher positive rates of COVID-19 than the rest of the population.

We also observed that there were very high COVID-19 rates in South King County which coincided with where communities of color live who had limited access to testing. This was a health inequity that we needed to address. We were also aware that people who are homeless are at high risk for contracting and developing complications from COVID-19 infections. We had to figure out a way to develop a testing program that would be easily accessible for these populations and communities and we needed to do it quickly. Mobile testing vans would allow us to be nimble.

Q: How did you identify the populations you wanted to serve with this approach?

LC: We looked at the data from UW Medicine, analyzing COVID-19 positive rates disaggregated by race, ethnicity, language and geography. This allowed us to identify communities in King County most at risk. In addition, we engaged with the Community Health Boards who represent many of the racial/ethnic groups that were disproportionately affected by COVID-19 to hear their stories of the challenges within their communities.

PH: Along with using the data and information from public health — Martine and I having worked in south Seattle specifically — knew there were communities there (Black, people of color, limited English proficient, immigrants) who historically have been marginalized and have had less access to healthcare. Given this, we wanted to prioritize south Seattle as a location for our first mobile van.

Q: What are some of the challenges you’ve faced getting these vans up and running? How did you overcome these challenges?

LC: One big challenge was to find funding for the program. Philanthropic support allowed us to jumpstart this effort and mobilize resources. Although we needed to work quickly, we wanted to ensure that our testing effort was safe and effective. We sought the input from Community Health Boards to better understand the facilitators and barriers to testing. This information provided valuable guidance as to how we would develop a testing program that would be meaningful, impactful and culturally sensitive.

Working out the logistics of a mobile testing program was no easy task. For example, we needed to find locations, ensure adequate staffing, figure out the traffic flow, outreach to the community, follow infection prevention protocols, provide interpretation support, and notify patients of their results. The teamwork, creativity and tireless effort by many of my Harborview and UW Medicine colleagues and the partnerships with multisector organizations such as community health centers, schools, colleges, faith-based organizations, local government, businesses and Seattle King County Public Health were essential in helping us overcome these barriers. It was amazing to witness the shared sense of responsibility and collaboration across Harborview, UW Medicine and the community.

Q: What is one thing you wish more policy makers understood about COVID-19 and its impact on underserved communities?

LC: The COVID-19 pandemic highlights the longstanding inequities that exist in our nation. We need to prioritize the health of individuals without privilege. In addition to providing access to high quality health services, we need to address the social determinants of health and environmental and community conditions that impact health to be successful. This requires collaboration among health care systems, communities and multisector organizations to identify health priorities, unite around shared goals, develop culturally tailored solutions and ultimately improve the health and well-being of the community during and long after the pandemic.

From the beginning, the University of Washington and UW Medicine have supported our state’s efforts to mitigate the effects of COVID-19. “Huskies fighting COVID-19” is a feature series highlighting individuals whose work is making an impact from Public Health and Computer Science & Engineering to the Virology Lab and the emergency room.

Huskies fighting COVID-19: Jack Davis

This week we connected with Jack Davis, AM Courier Lead for UW Medical Center Reference Lab Services (RLS) Courier Group. Davis has been working on the front lines of the pandemic in a role most of us don’t even think about. He shares his experience transporting specimens from testing sites to the laboratory — an often overlooked, but critical step in tracking disease transmission.

Q: For those who are not familiar, could you share what a medical courier does?

A: UW Medical Center RLS couriers collect specimens from outlying locations and transport them to our centralized specimen processing labs. Our two largest processing centers are the main lab on the Montlake campus and the Clinical Virology Lab. The Clinical Virology Lab handles all our COVID-19 specimen processing. We currently have some 20+ routes and our COVID-19 specific pick-ups. Couriers start as early as 6:15 a.m. and finish as late as 12:30 a.m. We work every day of the year.

A typical courier day involves driving a preset route. Couriers go to the same stops in the same order at the same time every day. We cover territory from Seattle to Moses Lake and Ferndale to Olympia. But we don’t really have typical days. Cars break down, tires go flat, people call in sick, our COVID-19 specific clients call with schedule changes and supply requests we can never fully anticipate. My ideal day is one where we have enough surge capacity to shoulder all planned and unplanned events without anything getting dropped or missed. And (knock on wood) so far we have always been able to make it work.

Q: Do you remember when you first learned about COVID-19? What were you thinking and feeling at that time?

A: Yes – it was March 2, a Monday. Talk of COVID-19 was in the air the previous week. I remember that on Friday, February 28, my supervisor said he thought CV-19 was going to be a big deal. I told him I disagreed – I figured it was just being overblown. Then, on Monday morning, Greg Pepper (manager of the Clinical Virology Lab at EVIR) told me that we were gearing up to be able to process 1,000 specimens a day. By Wednesday, that number was up to 5,000 a day. Later, it was adjusted to a goal of 15,000+. With hindsight, I see this as the time we stepped out of the known into a long surreal period of intense work beyond what any of us had done before.

Q: How did your work change as the weeks progressed?

A: Right away, change happened fast. Supply systems began faltering. Dry ice became impossible to keep in stock. Our quantity of specimen transporting totes proved to be too low. We needed more of everything. More drivers. More cars. More routes. More stops. More totes to transport specimens. More ice packs. More dry ice. We couldn’t get hand sanitizer for couriers or Sani-Wipes to clean cars. Masks simply did not exist. Frequent handwashing was the advice offered.

The processing systems for incoming specimens were never designed to handle the volume of samples COVID-19 unleashed on them, and there was no time to redesign the process. SPS put out a call for volunteers and threw bodies at the problem. People came from other labs. Folks came out of retirement and volunteered. People worked 7 days a week; did double shifts. Doing whatever it took was how jobs got done. Nothing was sacred. If something worked better than the current way, better was what we did. And through it all, couriers performed flawlessly. When asked to stay late, they did. When asked to make extra stops, they did. Every courier stepped up to the best of their ability to get the job done.

Eight months into these COVID times so much has changed, yet so little is different. We continued to see an unrelenting pace of COVID, COVID, COVID. We continue to transport COVID-19 specimens in large volumes on a steady basis and service COVID-19 specific clients in addition to our regular routes.

Q: Why did you choose to work as a medical courier?

A: I started as a medical courier because it offered decent benefits and was a good part-time job to help my transition from having been a boat builder/Composites Construction Project Manager to becoming a writer. But something happened. At some point, the service aspect of courier work hooked me. An experience from my old route gives a good example. On the route I drove, there was a patient I saw every day. She was a wonderful women; full of positive energy. One day she told me that just seeing the bright Hawaiian shirts I wore always made her day a little lighter. Sadly, she passed away, but her daughter made a special trip to tell me how much I had meant to her mother just by my simple daily actions and attitude. Over the years, these experiences began to accumulate and being of service became an important thing to me.

Q: During this difficult and often stressful time, what keeps you going?

A: Someone at UW Medical Center said this COVID-19 work is the most difficult, frustrating and rewarding work they have ever done. I agree.

What keeps me going is faith. Years ago, I spent two months at a boat building school in Maine created by Lance Lee. Lance told a story about a rock on Hurricane Island. It was about 6 feet tall and had a sheer face on one side, but you could easily walk up the back of it to get to the top. He used it for a team/trust/relationship building exercise. Your task was simple. Stand at the top of the rock with your back to your teammates, close your eyes, spread your arms and fall backward trusting that your teammates would catch you. Lance said the experiences on that rock were transformational for many people.

For me, this COVID experience is like that rock. There are huge numbers of people working together, doing better than any of us have a right to expect with the information and circumstances they have to work within. It is that faith-based teamwork experience I find transformational. It is not a religious faith, but a faith in teamwork, trust-based relationships and a passion to do the best work possible no matter the circumstances. COVID-19 eradication will not be fast, nor pretty, but with faith and trust we will undoubtedly triumph in the end. For me, the way forward is to Fall Like On Hurricane (FLOH) and doing that has made all the difference.

Huskies fighting COVID-19: Denise Batura

This week we connected with Denise Batura, ICU nurse at Harborview Medical Center. Batura has been working on the front lines of the pandemic in the Harborview COVID-19 ICU. She shares her experience caring for patients and serving families during this unprecedented time.

Q: What inspired you to become a nurse? What keeps you going?
A: I always knew that I wanted to be a nurse. I love people and caring for them. What solidified me pursuing a nursing career was working in a long term care facility and loving being around the elderly and learning about them as a person, listening to their stories and life experiences.

I have been a nurse now for 25 years, and I continue to love it. Nurses are an amazing group of people that I am proud to be a part of.

Q: Do you remember when you first heard about COVID-19? What were you thinking and feeling at that time? How did that change as the weeks progressed?
A: When I first heard of COVID-19 it was early February. To be honest I was not that concerned about it. I remember when there was the Ebola outbreak in Africa in 2014. Harborview had a plan in place with a team of nurses, respiratory therapies and doctors to care for them. I think our hospital had one Ebola case or rule out. Nothing catastrophic.

I had been planning several ski vacations, one to Colorado in February and the other to Banff in Canada early March. While in Banff, COVID became very real. It was all over – the news of the outbreak – and that it had reached the United States, my home Washington. I was traveling with two friends’ nurses. We were flying home on March 12th wondering if we would be allowed back in the States. I remember being extra careful wiping down our area with sani wipes and using the septic nasal swabs prior to our flight. I remember covering our faces with our jackets on the plane ride home. COVID was becoming very real flying home to where someone had died from it. COVID-19 had made it to Washington.

My vacation was over and I was in charge of the COVID ICU. I was given detailed instructions on how to train others on entering and exiting the patient’s room. We had all been trained early in the year on proper donning and doffing [of personal protective equipment]. COVID-19 took it to a new level. Not only did we don and doff very methodically, steps had been added to safely enter and exit a room with cleaning doors and surfaces multiple times with each entry and exit. There was and still is a trained observer to watch and make sure you enter and exit the room safely. It was intense.

My work day involved dressing in PPE, wearing scrubs (no street clothes or undershirts), scrub pants either rolled up or tucked in your socks so they didn’t touch the ground, a plastic gown, hair pulled back, a mask (N95 or PAPR) and eye protection. We’d try to cluster care so that we were not going in and out of the room. Not to mention making sure we were hydrated and had gone to the bathroom before we went in. You could expect to be in your patient room for hours. And when I did leave the room, I would be drenched, my scrubs soaked from sweat.

As the world learned more about the virus so did we. We adapted to COVID-19 and how we entered and exited rooms. Procedures would continue to evolve and treatments and therapies would change. The COVID ICU or our nickname Camp Covid continues to be up and running. It is staffed by neuroscience intensive care nurses as well as other nurses from other intensive care units. Caring for these patients has been exhausting.

One of the hardest things I have experienced with COVID-19 is when a patient is admitted to our ICU who is talking to us, alert and oriented. They feel terrible, are having trouble breathing and are scared. We are all hoping the medication and therapies like self-proning will work. But there are times when nothing works and they continue to struggle to breathe, becoming more short of breath, eventually requiring full life support. It is different from any other illness.

Q: With family members not being able to physically be present, has your role as nurse changed or adapted to help people connect with their loved ones? If so, in what ways?
A: COVID-19 prohibits any visitors from coming to the COVID ICU. This means families cannot be at their loved one’s bedside. Communication with families to the patient has been with Zoom on a laptop in the patient room. There have been many heartbreaking moments to hear families talk to their loved one, children sharing what they had done that day and spouses singing or just sharing stories of their day. Many times tears would roll down my face as I stood there listening to how much they love the person lying in the bed. Families would be so thankful for time spent “zooming.”

There are those who have conquered the virus and left the unit which is cause for celebration. We line the hall with staff to cheer for them as they leave Camp Covid. And there are those who are not as lucky. The individual who continues to do poorly despite all efforts. And the call is made for the family to come and say goodbye. Two family members are allowed into the patient’s room for 20 minutes and then they are escorted off the unit. It is absolutely devastating.

Q: This year has been stressful for so many of us. Is there anything you find helpful to care for your mental health and wellbeing as the pandemic continues?
A: To say this pandemic has been stressful is an understatement. So much has happened it is difficult to put into words. However, I can honestly say I love my job. I love being a nurse and the people I work with. They are all amazing individuals. We carry each other.

For me, keeping my spirits up and surviving this pandemic is taking it one day at a time.
Exercising, getting outside, and journaling which I started in June. I continue to be thankful for my own health.

Q: What is one thing you wish more people understood about the pandemic?
A: People and the community need to be less careless. Be aware of your surroundings, be aware of your own health. Please do the simple thing of wearing a mask. If you are not feeling well, stay home!!

Huskies fighting COVID-19: Shwetak Patel

This week we connected with Shwetak Patel, Washington Research Foundation Entrepreneurship Endowed Professor in Paul G. Allen School of Computer Science & Engineering and Department of Electrical & Computer Engineering at the University of Washington. Since the outbreak of COVID-19, Patel and his team have redirected their research efforts to focus on the development of new mobile tools for supporting rapid diagnostic testing, symptom detection and monitoring and contact tracing in partnership with other Allen School researchers, UW Medicine physicians and local software industry volunteers.

Q: How has your work/focus shifted with the emergence of COVID-19?

A: Much of my work was already focused on digital health with a particular emphasis on global health. The pivot to COVID was pretty straightforward given some of our work in Rapid Diagnostic Test, Pulmonary, etc were in some ways related to COVID. We applied a lot of what we learned in global health towards the pandemic which includes enabling frontline workers, developing easy to deploy tools, etc. It was interesting to see most of the lab pivot towards helping with COVID related efforts even if their research didn’t directly touch it.

Q: What Computer Science and Engineering COVID-19 related projects should policymakers and the business community know about?

A: There is the full list of CS&E COVID-19 related projects here. I urge people to think broadly about the how computational tools can help with the management of COVID cases, the prediction of outcomes, prediction of where resources may be needed, tools to enable remote monitoring and triage and finally telemedicine.

Q: Could you share an update on the progress of developing the CovidSafe contact tracing app? When do you think it will be ready to launch?

A: The CovidSafe app is now called CommonCircle. This was developed by a CS&E team and the [UW] Med School with substantial help from software engineer volunteers in the region. The app has gone through a round of piloting on UW campus and the team is gearing for a launch this fall for students, staff, and faculty. The other goal of the effort is to create an open source app that others can also build off of as well.

Q: What is one thing you wish more policymakers understood about how technology can help communities combat the coronavirus?

A: Flexibility and a strong dialogue between the technology community and policymakers is really important. We should certainly develop technology with strong principles in place, but many times it was hard to predict the positive or negative impact of a technology. It is how we respond and adapt. Also, I see technology has an enabler or amplifier and not the primary solution. We need to think about the public health and technology policies hand in hand when appropriate.

Q: When you look into next year and beyond, what challenges do you foresee for our communities as we continue to navigate this crisis? How can we ensure we navigate these challenges in a way that is equitable to all?

A: I think the biggest challenge for me is public perseverance and the widening gap in health disparities. Based on all indications, this is something we are going to have to navigate for a long time and there will be bumps in the road as we iron out testing, develop a vaccine, and develop healthy workforce practices. I worry we stop innovating or let our guard down just by getting “tired” of the situation and at the same time we innovate to only help a small portion of the population whereas we need to think about helping EVERYONE. When it comes to equity, we can think about making sure our innovations don’t create larger disparities. For example, focusing on multiple platforms, lower end and higher end phones, access to technology and digital literacy. Stakeholder analysis and formative user research can go a long way prior to designing any technology.

Shwetak N. Patel is the Washington Research Foundation Entrepreneurship Endowed Professor in Paul G. Allen School of Computer Science & Engineering and Department of Electrical & Computer Engineering at the University of Washington, where he directs the Ubicomp Lab. His research interests span Human-Computer Interaction, Ubiquitous Computing, Sensor-enabled Embedded Systems, and User Interface Software and Technology. His past work has included the development of whole-home, energy, and water sensing systems, mobile health applications for detecting and managing disease, and new interaction technologies.

Huskies fighting COVID-19: Dean Hilary Godwin

From the beginning, the University of Washington and UW Medicine have supported our state’s efforts to mitigate the effects of COVID-19. “Huskies fighting COVID-19” is a feature series highlighting individuals who’s work is making an impact from Public Health and Computer Science & Engineering to the Virology Lab and the emergency room.

This week we connected with Hilary Godwin, Dean of the University of Washington School of Public Health and professor in the Department of Environmental & Occupational Health Sciences. She shares her insight on understanding the impact of lagging data, connecting with others safely during the pandemic and preparing for upcoming challenges as we look to 2021.

Q: We keep hearing in the news about case counts going up, particularly among young people. What do you think it will take to get the virus under control enough for counties to continue the reopening process?

A: I think that, to be able to continue the reopening process safely, we will need much broader adoption of social distancing and face-covering guidelines than we currently have. I tend to think of it this way: we have enough public health and healthcare infrastructure to be able to handle a certain number of cases at any given time (without having the number of cases surge out of control) and that basically means that we as a community can tolerate a certain amount of exposure/transmission risk. I think that our top priorities as a society should be to use that “quota” of transmission risk in a way that allows us to open critical segments of the economy and, ideally, to open K-12 schools. What we learned from our early attempts at re-opening (and the resulting uptick in cases) is that doesn’t leave a lot of bandwidth (in terms of transmission risk) for activities that may bring us joy but are not essential, unless we want to risk a new surge in cases. Although “opening schools before bars” may seem like a no-brainer, this is a hard reality for many people to accept, particularly when we may be looking at trying to contain this pandemic for another year or two.

Q: Has the emergence and continuation of the COVID-19 pandemic changed or affirmed how you think about the Public Health field? If so, in what ways?

A: The COVID-19 pandemic has definitely reinforced to me the importance of investing in prevention and making decisions based on data, both of which are core tenets of public health. The pandemic has also really highlighted the need to address social inequities and injustices that are pervasive in our society, including racism, as these are primary sources of the health disparities we see in our country. I have also found the pandemic to be humbling: we in public health need to do a better job of communicating consistently and clearly to policy makers and the public in general; we also need to develop better mechanisms for coordinating with each other and with other stakeholders both nationally and globally.

Q: What is one thing you wish more policymakers understood about the pandemic?

A: I wish more policymakers understood how data lags impact our ability to control the pandemic. There is a significant lag between when a person gets infected and when they show up as a case, and even greater lags for hospitalizations and deaths. Some of this has to do with access to testing and testing capacity, but a lot of it also has to do with the natural timeline for disease progression for COVID-19. These lags mean that by the time we know we have a problem, we are already a couple of weeks behind (and the problem has most likely be growing exponentially during that time). That means that we are inherently trying to make our best educated guess about how the pandemic is trending so that we can take action proactively before things get out of control. That’s a very hard concept for a lot of folks to grasp. People often would like to wait to be “sure” that action is needed, but by then, it may be that much harder to get the pandemic back under control.

Q: The COVID-19 pandemic has changed how our communities work, eat, play and socialize. Do you have any tips for folks who may find themselves struggling to find connection while following public health guidelines?

A: My husband and I have this conversation all the time: he is more social than I am (I am more of an introvert) and really misses socializing with other people. We also both miss spending time with family, who are all out of town for us. We have implemented weekly Zoom calls with my extended family as one way to cope with not being able to travel to see each other.

For getting together with friends and family that live nearby, I recommend what I call the “Fauci rules” (see this story in the Washington Post): if you get together with people, limit the number of people from outside your household, get together outdoors, maintain 6 foot separation and wear masks (other than when you are eating). If it’s too hot or rainy, then reschedule for another day.

This works now, because we have relatively good weather, but is going to be harder when things get colder. One strategy to consider as we head into the fall and the spring is to form a “pod” with another household that shares your level of commitment to social distancing and agree that both families will forgo interactions with other people so that you can spend time indoors with each other. (This is also a possible strategy for families that want to share childcare and remote school support for their kids.)

Q: When you look into next year and beyond, what challenges do you foresee for our communities as we navigate milestones like vaccine distribution once one becomes available? How can we ensure we navigate these challenges in a way that is equitable to all?

A: I was talking with a friend today who expressed that he can’t wait for 2020 to be over. I think most of us would agree with that sentiment!

One challenge that I foresee is that we haven’t been talking enough (or honestly enough) about what 2021 is likely to look like and how we should be planning for that reality. Because we likely won’t have large numbers of doses of vaccines until mid-2021 at the earliest, and it will likely take months to get those vaccine doses broadly distributed, much of 2021 is likely to look and feel a lot like the last five months have looked.

I anticipate that we will continue experience local surges in cases as we reopen different segments of the economy throughout 2021 and that will mean short-term returns to more restrictive measures to bring those surges under control. I also anticipate that we will continue to experience supply chain issues for testing reagents and supplies and that we will see something similar happen in the realm of vaccines. Because we have never mounted such a large scale vaccine campaign, I anticipate coordination will be challenging, particularly across state lines and globally. We also have a history of vaccine hesitancy in this country that will likely further complicate any vaccine campaigns.

I do think that, the timing is right to collectively lift our gaze up from the chaos of the moment and think constructively about what we can do to better prepare ourselves, our organizations and our communities for the upcoming year. Within my organization, we are having conversations about how we can best support each other in the upcoming year given this reality. I am particularly concerned about how we support our employees who have young children at home and are juggling working, parenting and teaching their kids. This means being flexible both in terms of schedules and in terms of expectations. On a societal level, I am particularly concerned that we continue to maintain the social safeguards that were implemented early in the pandemic (e.g., eviction moratoriums and unemployment benefits) and that we make sure that we are making critical services (including testing and vaccine) broadly available (and ideally free of charge). Finally, we need to make sure that, in the midst of the COVID crisis, we don’t lose sight of the importance of addressing racism and other social injustices now, so that we can emerge from this pandemic stronger and better as a society. We have a lot of work in front of us.