Our hurricane preparedness helped serve as a blueprint for dealing with the onset of COVID. We now have a robust supply chain, and our resources are spread across the system. —John Carter, MD
Explore This IssueNovember 2020
With New Orleans hospitals wiped out, and half of LSU’s residents and even more of its faculty gone from the area, the facility’s otolaryngologists offered their services in neighboring cities that weren’t as severely affected, such as Baton Rouge and Lafayette. “We were warmly welcomed [by other cities in the regions that were less affected] to bring our patients, residents, and students, which enabled us to resume normal business and start rebuilding the elements of an academic program,” said Dr. Nuss, who now gives talks to physician groups about emergency preparedness. As for LSU’s displaced residents, the broader otolaryngological community stepped up with offers to continue their programs at places such as MD Anderson, the University of Pittsburgh, and the University of North Carolina.
Rebuilding from Katrina has led to changes that have yielded lasting benefits. “Interestingly, one of the earliest innovations was by necessity—we got into telemedicine to a much greater extent than we had before,” said Dr. Nuss. “Faculty members who traveled to points far and wide were still able to furnish consultations. We learned then what many people are learning today from the COVID-19 experience: Telemedicine is a convenient and very useful tool for assessment and giving therapeutic advice. It can be a wonderful tool for triage as well.”
Adapting Past to Present and Future
The particulars may vary, but each disaster leaves an indelible imprint and lessons that become part of daily life. “The disaster experience creates an institutional memory that persists permanently,” said Jason Y.K. Chan, MD, MBBS, director of undergraduate teaching and an associate professor in the department of otorhinolaryngology, head and neck surgery at The Chinese University of Hong Kong. Dr. Chan cited the 2003 SARS infection as a game changer for the facility. “Since then, we have continued to wear masks and gowns in clinics,” he said. “Everyone is fit-tested for N95 masks on starting a job in a public hospital. There’s always a good stock of PPE available.”
The protocols put in place at The Chinese University of Hong Kong to address COVID-19 reflect a grim sense of reality regarding the management of infectious disease. “We’ve just had our third wave, so our operations stop and start,” said Dr. Chan. “Elective operations have been cut during waves, and there’s a longstanding effect as we work to clear a backlog of patients who need to be seen again.” He foresees no change to this status for “the next one to two years at a minimum.”
“Our hurricane preparedness helped serve as a blueprint for dealing with the onset of COVID,” said John Carter, MD, section head of pediatric otolaryngology–head and neck surgery for Louisiana-based Ochsner Health System in New Orleans. “We now have a robust supply chain, and our resources are spread across the system. For COVID, we were able to shift patient admissions to facilities with more capacity and move physicians, nurses, and medical assistants as needed to handle the surge. I was blown away to work with people from all different specialties who were there to help. The response from our team was incredible. The resiliency we gained from our experiences makes it easier to pick up the pieces and rebuild.”
Rohan R. Walvekar, MD, clinical professional and director of the Salivary Endoscopy Service and co-director of the ENT Service at the University Medical Center in the department of otolaryngology–head and neck surgery at LSU, participated in the post-Katrina rebuilding led by Dr. Nuss. “What I see as most relevant in dealing with the aftermath of a disaster—and which also set the stage for facing other challenges, including COVID-19—was to find the true strength of a collective team and mind,” he said. “Given the challenges we faced as a department in the past, when the COVID pandemic became apparent and New Orleans was one of the hot spots, we rallied together. We took stock of the situation, held working group sessions to prioritize and triage efforts related to patient and surgical care, and connected regularly to share information and harness resources to keep our residents, staff, and faculty safe.”
Consensus among disaster-experienced otolaryngologists is that information sharing is paramount. “The most important piece in my eyes is constant communication with our people and a clear, concrete plan for each clinic and hospital site across the system. This reduces confusion and anxiety,” said Dr. Carter. “That being said, we’ve learned from storms like Katrina and with COVID-19 that communication is often fluid; you have to be malleable and understanding enough to deal with a rapidly changing situation.”
Dr. Walvekar agreed. “One of the major challenges is being able to sift through the quantity of new and constantly emerging data on the nature of a healthcare entity that there was so little information on,” he said. “One of the ways we managed this was by diligently following state health recommendations, putting our patients’ and team members’ safety first, and preparing adequately for situations where we had to be on the front lines. We created task forces to help with decision making. For example, we created a committee for surgical optimization and resource utilization to help triage elective surgeries and maintain a database of decisions made so we could learn from them.”
The advancement of technology in recent years has been instrumental in this effort, said Dr. Kluka. In 2012, she moved from Louisiana to a beach community in Florida, where she’s division chief of otolaryngology at Nemours Children’s Specialty Care in Pensacola. Recently, Hurricane Sally brought strong winds, heavy rainfall, and a tidal surge to the area. Despite the resulting hardships, the experience was different. “Between 2005 and 2020, technology has improved dramatically,” she said. “With Sally, clinics and hospitals communicated announcements with employees readily, texts and emails were uninterrupted, and most of us were able to check with colleagues and associates regarding safety and resource needs.”
Online resources have also proven indispensable. “The transfer of knowledge has been greatly facilitated by social media, publications, and webinars, allowing for great discussion and quick responses,” said Dr. Chan. The online COVID-19 ENT resource library created by LSU to expand information sharing is an example of one such resource.