Dr. Patrick Remington, MD, MPH, is Professor Emeritus, Department of Population Health Sciences and Director of the University of Wisconsin - Madison Preventive Medicine Residency Program
On Saturday, March 21st, 2020, I was contacted by the Deputy Secretary of the Wisconsin Department of Health Services, requesting assistance from our Preventive Medicine Residency Program, in their COVID-19 Pandemic response. Our academic health system had just announced that we were in Stage 3 status, representing an extraordinary circumstance where routine graduate medical education must be reconfigured to focus on the pandemic response (https://acgme.org/COVID-19).
Beginning Monday, March 23rd, our residents suspended their ongoing duties and were reassigned to report to the Chief Medical Officer at the Department of Health Services.
A second year, PM-2, resident is focusing on enhanced data collection on COVID-19 cases in Wisconsin for the Mortality Unit and the Novel Coronavirus (NCOV) Response Epidemiology (EPI) Surveillance State Coordination Unit. This involves in depth investigation of a sample of cases from each state jurisdiction. He will also be exploring the feasibility of providing guidance to local health departments as well as to the 60+ WEDSS volunteers who have come on board to assist with case tracking.
Another PM-2 resident is the lead staff person for an Advisory Committee for Resource Allocation, comprised of physicians and bioethics leaders from around the state. The goal of this committee is to make recommendations for the allocation of scarce resources, such as ventilators, to hospitals throughout the state. She is synthesizing and analyzing existing state and institutional guidelines on allocation of resources in situations of scarcity. This work must be completed as soon as possible, as Wisconsin’s epidemic is projected to peak in late-April/early May.
A first year, PM-1, resident is consulting the Department of Corrections and local jails regarding infection control questions for COVID 19, serving as the point-person for the Correctional and Detention Facilities infection control outreach program that is being developed in conjunction with the National Guard and the Departments of Health Services and Corrections. She created a “COVID-19 Infection Prevention and Control Assessment Tool” that will be used during site visits to DOC facilities, which will be of value to the jails in assessing their infection prevention and control plans for COVID-19.
Another PM1 resident is working with the Department of Health Services and Riverside Corporate Wellness to assist in developing an online self-assessment with a self-care guide and nurse triage lines. The primary goal of the online self-assessment is to try and reduce the burden on urgent care and emergency rooms during the coming weeks by advising people to shelter in place if mildly symptomatic. Secondary goals include data collection, resource management, and linkage to care as appropriate. There is an option for a phone interview if the patient requests with higher risk individuals prioritized for the nurse triage line.
In discussions with other residency program directors throughout the nation, I have heard that their health systems have interpreted the guidance from The American Council for Graduate Medical Education (ACGME) literally: “Stage 3 – crossing a threshold beyond which the increase in volume and/or severity of illness creates an extraordinary circumstance where routine care education and delivery must be reconfigured to focus only on patient care.” However, at this stage of the epidemic, our system is meeting its clinical demands, but our public health system was not meeting the demands of pandemic response.
Our hope is that our support of Wisconsin’s public health system will be effective in “flattening the curve,” by improving our surveillance system, preventing spread in correctional institutions, providing triage to people who need information and not health care, and developing guidelines for allocation of scarce resources. If not, our residents are ready to join their colleagues in the health system at the front lines of patient care.